22 April 2002

1. Stereotypical Movements
2. Elevated Amylase
3. Why No Treatment?
4. Rash - Fungal, Bacterial, Then Eczema, Now Fungal.....blah, blah, blah!!
5. Mineral Oil Not for Constipated Infants
6. Nutrition Related Illness
7. Stretch Marks
8. Secretin for Autism
9. Disclaimer

• Read Questions & Answers in Another Column

Stereotypical Movements

Could you advise me of a diagnosis for the behavior my niece exhibits, where to seek the appropriate help and what-if anything-we could do to help my niece through this.

Thank you, sir, for taking the time to read the above. Our family is in great hopes that you will be able to educate us in this matter.

Sincerely,
Kathrin

Dear Kathrin: Stereotyped behavior as you describe is often seen as part of pervasive developmental disorder (previously known as autism). Asperger syndrome is a variant in which the patient has normal or above normal intelligence. Lack of proper social interaction with other people is a hallmark of these disorders. The child's mother's lack of affection and concern for her child could indicate that the mother has the same condition. Of course I can't make a diagnosis over the internet, but since the child has school problems, an evaluation by a pediatric neurologist would be appropriate and may be more acceptable to the parents than a psychological evaluation.

Sincerely,
Dr. Warren

Thanks so much, we'll be looking forward to your reply.

Sincerely,
-Kathrin

Dear Kathrin: You will not find any reference to your niece's specific movements in the literature about Asperger Syndrome or autism. These are referred to as stereotyped movements. A stereotyped movement is a movement in response to a situation which is not purposefully related to the situation and is not a typical human response to the emotional situation, and yet, it is predictable that this response will be repeated in a similar situation by the person who has stereotyped movements. Essentially, most people find these stereotyped movements to be an odd response to a given situation. The stereotyped movements may be unique to a particular individual. Stereotyped movements are a feature of Asperger Syndrome and autism.

Sincerely,
Dr. Warren

I wish to know about slightly raised Amylase.

I have no symptoms of abdominal pain and my health is fair. Only one problem is teeth and bleeding gums. My whole abdomen ultrasound is normal including pancreas and gall bladder. My fasting blood sugar, serum lipase, lipid profile and calcium are normal. Moreover, other blood tests are normal. But still my Amylase fluctuates. Sometime, it is 150 and sometime it is 190. Normal range here is ( 25 to 125).

I have been checked by G.I ( Gastro-Entrologist ), and he is not worried.

Interested to know reason and remedy of raised Amylase. I am non-alcoholic and non-smoker.

I will highly appreciate your reply on above.

Thank You.

-Iqbal

Dear Iqbal: Amylase is an enzyme which is produced by the pancreas and the salivary glands. Intraabdominal pathology can cause an elevation of the amylase by irritating the pancreas. Inflammation of the pancreas or obstruction of the pancreatic ducts generally causes extremely high elevation of serum amylase.

Inflammation of salivary glands can also cause elevation of the serum amylase. Amylase is generally elevated with parotitis such as caused by mumps. I am not sure whether the condition of your gums and teeth might be affecting your salivary glands.

Elevation of the amylase is a laboratory finding which can point toward certain conditions. It is not an illness in itself. it does not cause any specific symptoms. A wise physician treats patients, but not laboratory tests. There is no treatment indicated for an elevated amylase if all your evaluations for possible causes of this elevation have been normal; however, periodic surveillance to be sure there is no pancreatic pathology is probably warranted.

Sincerely,
Dr. Warren

Thank you for you help.

-SD

Dear SD: Who told you that your son has a bacterial infection? If it was a doctor, he would be the best person to ask what the treatment should be. It would seem reasonable to treat a bacterial infection with an antibiotic, but since no treatment was prescribed, there must be a reason. Perhaps there is some misunderstanding about the diagnosis. You need to talk to the doctor who saw him. If he wasn't seen by a doctor, after 4 weeks of having a rash, it's time.

Sincerely,
Dr. Warren

-J

Dear J: I cannot fully answer your question because I haven't seen the rashes and there appears to be a difference of opinion about what the rashes are; however, I can tell you the following:

• Ringworm (fungus infections of the skin) can certainly come from kittens, if the kitten is infected.
• Fungus infections are slow growing an slow to resolve. It could take 2 to 4 weeks of treatment for full resolution. Sometimes longer.
• Ringworm of the scalp cannot be treated with a cream because the fungus gets into the hair shaft. Ringworm of the scalp must be treated with medication by mouth.

Sincerely,
Dr. Warren

Thank you

-NT

Dear NT: If a 12 week old hasn't had a bowel movement in 3 days but is eating well, not having any cramps, abdomen is not distended (swollen), and the bowel movements are usually soft, the only thing you should do is wait for the baby to have a bowel movement on her own. If the baby becomes uncomfortable, then rectal stimulation with a lubricated thermometer or a glycerin suppository can help to induce a bowel movement. If the stool is hard, some dietary changes may be necessary to help keep the stool soft.

Mineral oil is useful for treating constipation associated with stool withholding. It isn't the appropriate choice for a 3 month old. I would caution you, and all my readers that the younger a child is, the more care you should exercise in following medical advice that was used to treat an older child or adult. I don't anticipate that the mineral oil has done any harm, but I would discontinue using it.

Sincerely,
Dr. Warren

-PM

Dear PM: Your question is, perhaps, a bit too open ended to give an answer. In the normal practice of pediatrics in the USA we do not generally see diseases related to nutrition. The main nutritional problem in the USA is obesity caused by overnutrition and inactivity. Obesity often starts in young children even before 3 years of age since they may be genetically predisposed to it and their parents allow them to use their bottles to calm themselves. A related problem is cavities caused by excessive sweets.

In other parts of the world malnutrition causes illnesses like mirasmus and kwashiorkor. These are not specific to any age group. Poor choices of nutrition as well as inadequate nutrition can lead to vitamin deficiencies. Again these are not age specific, and for details, I suggest you look up information about the various vitamins. This information is readily available from a variety of sources.

Other illnesses related to nutrition but not caused by specifics of the child's diet alone may not be what you are looking for, however, consider that the child with diabetes has some very specific nutritional needs. Food allergies and lactose intolerance can also make specific dietary changes necessary. Rare metabolic disorders which require special diets, e.g.., phenylketonuria, usually become evident during early infancy, but a person with G6PD deficiency may be asymptomatic even into adulthood and have a hemolytic crisis provoked by eating Fava beans.

After you have researched some of these possibilities and decided where you want to focus your attention, if you have some specific questions, I would be happy to see if I can answer them.

Sincerely,
Dr. Warren

Please respond as soon as possible .

-JT

Dear JT: Stretch marks occur in areas where rapid growth exceeds the normal growth rate of the skin. This may occur in a variety of places in the rapidly growing adolescent. In obesity it is commonly seen on the abdomen, buttocks and thighs. Adolescent girls may sometimes get stretch marks from rapid growth of their breasts. Pregnancy often causes abdominal stretch marks. To the surprise of many young men, rapid muscular growth associated with working out can sometimes cause stretch marks.

Stretch marks are harmless, but most people are bothered by the appearance. Unfortunately, they are permanent.

Sincerely,
Dr. Warren

-GC

Dear GC: The information on the Morning show was probably based on the following study:

Improved social and language skills after secretin administration in patients with autistic spectrum disorders. by Horvath K - Journal of the Association for Academic Minority Physicians - 1998; 9(1): 9-15
Author Affiliation: Department of Pediatrics, University of Maryland School of Medicine, Maryland, USA.
Authors: Horvath K; Stefanatos G; Sokolski KN; Wachtel R; Nabors L; Tildon JT
Abstract: We report three children with autistic spectrum disorders who underwent upper gastrointestinal endoscopy and intravenous administration of secretin to stimulate pancreaticobiliary secretion. All three had an increased pancreaticobiliary secretory response when compared with nonautistic patients (7.5 to 10 mL/min versus 1 to 2 mL/min). Within 5 weeks of the secretin infusion, a significant amelioration of the children's gastrointestinal symptoms was observed, as was a dramatic improvement in their behavior, manifested by improved eye contact, alertness, and expansion of expressive language. These clinical observations suggest an association between gastrointestinal and brain function in patients with autistic behavior.

To have your son treated with this medication, you would probably have to participate in a study since the drug is not currently approved for such treatment. For further information on this possibility, you might try contacting the Department of Pediatrics, University of Maryland School of Medicine to see if they will be conducting any further studies or if any university medical center near you might be participating in such trials. The producers of the TV show might also be able to provide you with additional information. Finally, you might benefit from networking with other parents of autistic children through local support groups or on the internet. They might be able to steer you in the direction of currently ongoing studies. A good place to start might be Parent Soup.

Sincerely,
Dr. Warren

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