11 March 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
Sincerely,
-A Worried Aunt
Dear Worried Aunt: Pneumonia is a potentially serious infection at any age, but there are so many factors which can influence the outcome, it's hard to predict. Complete recovery with out any future consequence is certainly the most likely possibility if there are no complications. If there is underlying lung disease, cardiac disease, or significant respiratory difficulty, the consequences may be more serious. To give you a better answer, I would need to know what led to the diagnosis of pneumonia and the course that the baby is following.
The most likely scenario, from what you've told me, is that the baby was ill, perhaps with a fever. As part of the evaluation, a chest x-ray was done which revealed a pneumonia. Since newborns have poorly developed immunity, many of the germs you an I live in peaceful coexistence with on our bodies can invade the newborn's body. Theses germs can multiply in the blood stream and cause pneumonia as the blood passes through the lungs. Or the germs can enter through the respiratory tract, cause pneumonia, and then invade the blood stream.
When we see a sick newborn, because they have so little immunity, sepsis (blood infection) is always one of our main concerns. At this age, Group B strep is one of the major pathogens, but any bacteria could cause a serious infection in the neonatal period. If caught early and treated with appropriate antibiotics, complete recovery is certainly possible. At the other extreme, late diagnosis and treatment or overwhelming infection can be fatal. If meningitis develops, consequences could range from complete recovery to deafness, seizures, brain damage, or death.
Sincerely,
Dr. Warren
Thank you.
-Monica
Dear Monica: Many asthmatics, especially young children with asthma, wheeze when they have colds. For some, that may be the only time they wheeze. If your daughter wheezes frequently when she has a cold, she probably has asthma. Some children do outgrow asthma, but many do not.
Sincerely,
Dr. Warren
-Jane
Dear Jane: If I had seen the news reports to which you were referring, I could comment more effectively on your concerns. I reviewed a few articles about serotonin and migraines, and serotonin and bulimia. My impression from these articles was not that a direct cause and effect link between serotonin levels and either condition had been established. In both instances the link was increased serotonin metabolites in the urine. This kind or research opens the door to possible treatments because of the availability of medications which affect serotonin levels. However, the causes of both migraine and bulimia are multifactorial. The elevation or serotonin metabolites indicating increased serotonin levels don't tell us whether the elevation of serotonin metabolism is related to the cause of the condition or as a result of the condition. Additionally, the reason that serotonin can be involved in such a diverse set of conditions such as migraine and bulimia is that neurotransmitters like serotonin work locally, meaning that the levels of neurotransmitters will only be significantly elevated in the part of the brain in which they are produced so that the effect they have depends on what part of the brain there is increased or decreased production in. The challenge in treating these conditions is to try to find medications which selectively work on serotonin or serotonin receptors in one part of the brain without having too much effect on other bodily functions affected by serotonin.
If there were an association between migraine and bulimia, one would have expected epidemiological evidence to have linked them before our knowledge of serotonin became available. When I searched for articles about the two conditions together I found none. It may be a matter of some interest that cyclic vomiting is related to migraine, but in contradistinction to bulimia, people with cyclic vomiting would prefer to not vomit and do not binge.
Based on my limited knowledge of the subject, I would say that people with migraines are not at increased risk for bulimia, but future studies may tell other stories.
Sincerely,
Dr. Warren
We have been seeing a pediatric neurologist and occupational therapist in response to concerns over his delayed development. OT has a hunch that it is more sensory than motor. An MRI is scheduled this week. Could there be any possible relationship between his persistent fever and his delayed development?
-Concerned and Confused
Dear Concerned and Confused: Some virus infections can cause fever for up to 9 days. By the time you receive my response, if your son is not better, further evaluation is warranted. The type of evaluation depends on the whole story and what your pediatrician finds on examination. Prolonged fever could be caused by occult infections like bone infection (usually associated with local pain) or urine infection, rheumatic diseases like JRA (which eventually causes swollen joints), inflammatory bowel disease (which eventually causes intestinal symptoms), or mononucleosis. There are some serious illnesses to be considered such as meningitis and cancer, but your doctor would know best if there is a reason to evaluate for those conditions.
Some tests may need to be repeated such as the CBC, chest x-ray, and urine culture. An ESR might be useful as a measure of inflammation. A high ESR would possibly suggest a need for rheumatologic evaluation.
I see no association with developmental delay and fever since the fever is associated with an acute illness and developmental delay is a long term problem; however, I don't have enough information (including never having seen your son) to rule out metabolic diseases which could cause a large variety of symptoms.
Sincerely,
Dr. Warren
-LG
Dear LG: Your son could be experiencing night terrors. Even though the term "night terrors" sounds so ominous, they are not a serious matter. A night terror is a specific type of sleep disturbance. Night terrors are similar to nightmares, but there are some significant differences. A child who has a nightmare awakens upset by a frightening dream. During a night terror, the child is not awake. Because the child is not awake, he does not respond to efforts at comforting him. When children do awaken from a night terror they have a vague sense that something frightening happened, but they have no recollection of what.
Since a night terror is a sleep disturbance, the management of recurrent night terrors usually involves interrupting the sleep cycle around the time the night terror usually occurs. If your child is only having the night terrors occasionally, that intervention would not be warranted. The night terrors will eventually pass. They are not harmful.
Sincerely,
Dr. Warren
-JD
Dear JD: Your son's height and weight are between the 75th and 90th percentiles. His weight is appropriate for his height. He is not overweight. He is big. He demands a large quantity of food to sustain his rapid growth. Given his large caloric needs, it may be too soon for him to sleep through the night. Many infants don't sleep through until 3 months. Formula is the appropriate food for your son to grow on. I would rather see him consume 40 ounces a day of formula, or more than start cereal at 2 months.
Some infants do consume too much formula and become obese. Those infants are generally large. The best way to be sure whether or not your son is gaining weight in excess of height is to review his growth charts with your pediatrician at each checkup. If your son's rate of weight gain is excessive, then diluting the formula may help. Based on the numbers you gave me today, it is not necessary or advisable to dilute your son's feedings.
Sincerely,
Dr. Warren
I would really appreciate any help you may be able to provide. Thanks so much.
-Nora
Dear Nora: At 8½ months your baby should not need to eat in the middle of the night; however, he probably uses the bottle to put himself back to sleep. You should start progressively diluting his formula in the middle of the night bottles until you are giving him just water. Then decrease the amount you give him in the bottle until you stop giving the bottle altogether. Read my article, Helping Your child to Sleep Through the Night.
Sincerely,
Dr. Warren
-S
Dear S: Certain antibiotics may make some birth control pills less effective. Your pharmacist would be the best person to tell you if you were in such a situation. If you were, in any cycle during which your birth control pill's effectiveness may have been compromised, you would have to use an alternate (backup) method of birth control. This would be true for the whole cycle in which you took the antibiotic regardless of how long ago it was finished. If you stop taking the birth control pills for any reason, it is advisable to use a backup method of birth control until you have been back on the pill for one full cycle. The antibiotic you stopped taking during the last cycle should not have any effect on the effectiveness of your pills during the current cycle as long as you did not stop taking the pills.
Sincerely,
Dr. Warren
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