25 February 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
-TK
Dear TK: It is certainly possible for an unborn child to be injured, but such injuries would generally involve significant trauma to the mother's abdomen. The uterus and amniotic fluid provide excellent protection to the unborn child. Trauma sufficient to affect the child would probably cause bleeding and result in going into labor.
The effect of the auto accident on the child is a moot point. If it did affect the child, it might help in understanding what happened, but if the child has medical problems, I don't see any way that information would alter treatment. An 8.5 month old who is twitching and has an active startle reflex ought to have an evaluation by a pediatric neurologist.
There are no tests indicated to look at your question about injury. Any tests should be directed at evaluating the child's current condition.
Sincerely,
Dr. Warren
Xxxxx is now ten weeks old. She weighs about 6lbs. 8oz., and seems generally in good health.
However, in the last month or so, Xxxxx has been vomitting more frequently and in greater volume. She does not "spit up." She vomits(!), both directly after feeding, and at various times between feedings. While her vomitting is not generally projectile, the volume and frequency were alarming enough that my wife and I brought her to the hospital (an HMO) for tests. All of the tests were negative.
Her doctor advised us to prop up her crib so that her head is elevated, and to thicken her formula with rice cereal. Her problem, he said, is mechanical, not chemical. Other than that, he said we'll just have to wait for her to grow out of it.
Xxxxx is still gaining weight, though not as quickly as her brother.
Is he right, or is there some treatment that the HMO is not willing to try? Will the early cereal have some future adverse effects? I worry that there could be some psychological effect; will she develop normally psychologically when she's constantly either hungry or throwing up? I'm sure you know the rest of my concerns.
I hope you can help. Thanks.
-E
Dear E: The question is not whether there is a treatment the HMO is unwilling to try. It's a sorry state of affairs that anyone even has to think that. The question is, is there a need for your daughter to be treated for anything. More to the point, does she need further diagnostic evaluation to see if there is anything wrong. Treatment would be decided based on the diagnosis, and the condition and symptoms of the patient.
Most babies have some degree of gastroesophageal reflux. Some do spit up such large amounts that they appear to be vomiting. The distinction between vomiting and spitting can be difficult, but in most instances, people who are vomiting either gag, or are nauseated. If a large volume comes up easily from your daughter's mouth and she is not upset by it and has a good appetite afterward, and does not appear to have pain, it is probably spitting rather than vomiting. The main exception to that description would be pyloric stenosis in which there is no nausea or loss of appetite; however, the vomiting is projectile with pyloric stenosis, and eventually the babies lose weight.
It is not important whether Xxxxx gains weight as quickly as her brother. what is important, is whether or not her rate of weight gain is normal. If she is gaining well, eating well, happy and not in pain, and not coughing or wheezing, her degree of reflux probably does not require further evaluation or treatment. If she is gaining poorly, colicky, irritable, sleeping poorly, coughing or wheezing, and/or has a poor appetite, she should see a pediatric gastroenterologist who may want to do an upper GI series, endoscopy, and/or a pH probe for further evaluation.
We're a long way from worrying about potential psychological effects. You should be able to tell right now whether or not your daughter is either constantly hungry or unhappy. By the time she is old enough to have any psychological reaction to vomiting she should be well past this stage. If she does have a medical problem, I expect you will come to a diagnosis and treatment long before she will be affected psychologically by vomiting.
Sincerely,
Dr. Warren
-Z
Dear Z: Two main possibilities come to mind.
Sincerely,
Dr. Warren
It is really making me feel upset
Please please help
Yours Sincerely,
-Col
Dear Col: As you enter puberty a variety of glands in your body become activated including glands in the skin, some of which produce secretions that have an odor. The dots you are describing under your foreskin are probably glands around the head of the penis. If these dots are large, red, and tender, you should have it checked by a doctor to be sure you don't have any infection. The glands under the foreskin secrete materials that act as a lubricant. If you find the smell objectionable, make sure that your pull your foreskin back when you bathe so that you can wash away the secretions, but don't scrub vigorously because if you irritate the head of your penis or the area under your foreskin, the glands will secrete more lubricant to protect the irritated tissue.
Sincerely,
Dr. Warren
Dear Dr. Warren: I am sure that you will have forgotten my problem which I told you of some time ago. I am 13 and for a while have had red dots on my fotreskin producing a bad almost fishy smell. Your advice was to wash under there but not vigorously, I have done this everyday since then, but with no luck , and I have been most delicate too, covering it in soap but not rubbing hard. You said that if these dots were red large and tender I should see a doctor, but they are not so I have not been-I am also quite embarrassed about my problem. I would like to ask you what action I should take now? Whether this is in my imagination but when I urinate the problem worsens, is it linked?
Yours Hopefully,
-Col
Dear Col: I'm sorry to hear that you're still distressed by an embarrassing odor. If you are washing yourself properly without irritating yourself, that should take care of any odor. However, the lubricants produced by your foreskin do have an odor, and now that your body is changing, that odor is probably stronger than when you were younger. At the same time, you're more concerned about your appearance and how you smell to others. As a result, you may be focusing on normal smells which others don't notice that you may need to get used to. You cannot make your body totally odor free.
At thirteen, you should be having regular checkups. And even though you find it embarrassing, your doctor should check your penis including pulling back your foreskin. I know your genitals are private to you, but your doctor sees private parts all the time. He's there to help you and care for you. So try not to be embarrassed. If you have a rash or other source of inflammation which is causing your foreskin to produce extra lubricant and therefore more odor, your doctor can help.
Urination does not increase the odor. You notice it more because you have to take out your penis and handle it to urinate.
Sincerely,
Dr. Warren
-ES
Dear ES: Before I'd try to guess what the problem was I'd want to know if the hands or toes were
Sincerely,
Dr. Warren
Thank you,
Sincerely,
-MN
Dear MN: Too often, people who are undergoing surgery don't meet the anesthesiologist until the time of the surgery, and yet, anesthesia is one of their biggest fears. To help you deal with that, you should arrange to visit the hospital and meet the anesthesiologist prior to your son's surgery. Yes, anesthesia is a risk. I can't promise you no risk there. But anesthesia has come a long way since I had my tonsils out under ether drip anesthesia 48 years ago, and I'm here to talk about it. A healthy 6 month old has no greater risk under anesthesia than an older child or adult; however, there are differences in pediatric anesthesia compared to adults. Just like you bring your 6 month old to a pediatrician instead of an internist, you want your anesthesiologist to have experience with babies. In fact, a pediatric anesthesiologist would be even better. Life saving, complicated surgery is done on sick, premature newborns. If that can be done well, certainly a hypospadius repair on a 6 month old shouldn't be too tricky.
Sincerely,
Dr. Warren
Thanks and more power to your company.
Truly yours,
-J
Dear J: When you say regular milk, I presume you mean formula. Infants should not be fed cow's milk instead of nursing or formula. If you feel you must offer your nursing baby formula, you can, but I would recommend that you do not offer formula unless it is absolutely necessary. In order for your milk to come in, the baby has to nurse. Any time you offer the baby something instead of your breast, you decrease the stimulation necessary to produce milk. In a way, offering a baby formula because you are worried that you don't have enough milk is one of the surest ways to guarantee that you may not have enough milk. The best road to successful nursing is to put the baby on your breast every time the baby is hungry and offer nothing else.
Sincerely,
Dr. Warren
-cCH
Dear CH: Even if I could give you a standard for the size of a baby's vaginal orifice, I would be concerned about whether you were accurately measuring what I am giving a standard for. This is not an issue for a layman to decide. If you have any concern that the child may have been abused, have her checked by a pediatrician and share your concerns and the reasons for them with him.
Sincerely,
Dr. Warren
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