19 August 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
-Frustrated Mother
Dear Frustrated Mother: All medicines have potential side effects, therefore, it's best not to be on medicine when it isn't necessary; however, sometimes it is necessary for a person to be on medication. There are some minor adverse effects to long term antibiotic use such as diarrhea, thrush (yeast in the mouth), and diaper rashes, but there are usually no serious consequences to long term antibiotic use.
As to why she continues to become ill, I cannot be sure based on the information I have. If she had a sinus infection, sometimes it may require a prolonged course of treatment to successfully eradicate. If she continues to have these problems a consultation with an ENT surgeon may help. On the other hand, if your daughter has had multiple upper respiratory viruses, it may just be that in her new environment she is being exposed to more URIs. Antibiotics are not at all helpful for these infections. Please read my article, Upper Respiratory Infections (URIs).
Since you feel the problem began right after you relocated, consider whether there may be specific environmental factors contributing to the problem such as dry air, exposure to fumes or smoke, allergy to something new in the environment, or a new childcare arrangement contributing to increased exposure to infection.
Sincerely,
Dr. Warren
Thanks
-DA
Dear DA: Some degree of lordosis is normal and is much preferable to a straight back. Excessive lordosis may be caused by obesity or postural habits which may respond to exercise. Since your son has no complaint, I would say no immediate attention is required, however, at 8 years of age, your son should have regular checkups at which time his pediatrician should check his back.
Sincerely,
Dr. Warren
Thank You
-JP
Dear JP: It is possible for an 8 month old to learn the meaning of the word "no" when your response to a situation in which you say "no" is consistent, in this case, taking him away from what you say "no" to. However, at 8 months, a baby does not have enough self control for you to depend on his response to the word "no." In addition, he may think this is a fine game since he has the opportunity to keep coming back to play the "no game." My advice is that whenever you are engaged in an activity which requires your full attention and may pose some danger to your child, make sure he is safely in his playpen where he can't get to the danger.
Sincerely,
Dr. Warren
Your response will be greatly appreciated.
-M
Dear M: As a general rule, medication prescribed for one person should never be used by another person without the specific advice of a physician to use it. Some medications, like antibiotics, are intended to be finished by the patient for whom they were prescribed. Use by another patient without being seen by a doctor may not only be inappropriate treatment for the second patient, but also would result in the first patient not getting the full course of his medication. If a patient were coughing, and borrowed another patient's asthma medicine, the treatment would only be helpful if the coughing patient had asthma, in which case, his treatment should be prescribed by a physician rather than borrowed from somebody else. Some symptomatic relief medications are available by prescription and may help another patient with similar symptoms, but I can't advise you without knowing the symptoms and the medication. Dosage of children's medications is generally based on weight, therefore, you would need the advice of a physician to give the correct dose.
Sincerely,
Dr. Warren
Thanks in advance.
-RS
Dear RS: There are many causes of eosinophilia which may be associated with cough. Eosinophilia may be caused by parasites, some of which, may cause cough when they are in the phase of their life cycle which passes through the lungs. Ascaris is one example of such a parasite. Allergies may sometimes cause eosinophilia, and of course allergies can cause coughing. Asthma causes considerable coughing and may sometimes be associated with eosinophilia. Some medications may cause eosinophilia. Tuberculosis causes cough and may sometimes cause eosinophilia. Hodgkins disease and other lymphoproliferative disorders may cause eosinophilia and sometimes be associated with cough. Eosinophilia and cough are part of Churg-Strauss syndrome.
With so many possibilities your son needs a thorough evaluation to determine the cause of his symptoms. The evaluation should start with a chest x-ray and pulmonary function tests. He should have a stool analysis for ova and parasites with treatment based on an accurate diagnosis. Evaluations by an allergist/immunologist and hematologist/oncologist may help clarify the diagnosis.
Sincerely,
Dr. Warren
She has experienced bouts of constipation and she is currently taking lactulose syrup daily. Even when she is clearly not constipated she still may continue to exhibit this positioning.
She has had an ultrasound, stool test, blood tests, barium enema, hip x-rays, visits to pediatric specialist. Everything always looks just fine when these test are run, which is good but we still are not able to do anything to help her. At this point all they can tell us is that she must be anticipating painful bowel movements. It just doesn't seem to fit, at least a good deal of the time.
We have also tried to rule out food allergies. We held back all dairy and tomato based products from her diet and it has not seemed to make a difference.
Her growth has always been excellent and all of her check-ups have been very good.
We also feel it is important to mention that during my pregnancy I took Tegretol (anti- siezure) and Levoxyl (thyroid medication). My pregnancy and her delivery were normal. She weighed 7 lbs and 11 ozs. - full term.
If you have ever seen any child experience this type of problem, please help us help her. We thank you for your time.
-JS
Dear JS: Since I haven't examined your daughter, I cannot be sure what is causing her symptoms, but it sounds like your daughter is withholding stool. That means, when she has an urge to have a bowel movement she goes to great lengths to hold it in. This includes squeezing her buttocks together, getting into a position that decreases her urge, and perspiring profusely from the effort.
Sincerely,
Dr. Warren
-NS
Dear NS: The CBC can be entirely normal with any kind of lymphoma. Enlarged lymph nodes can result from infectious illnesses including cat scratch disease and localized infections; however these inflammatory nodes are generally tender.
Sincerely,
Dr. Warren
At nite he is waking every 2 hours crying and daytime naps on their shoulder for short naps of sometimes an hour or less, once in a while in the crib but for not so long. He is doing fine weight wise, slightly under than over, but his doctor is not concerned. Baby had a cystal-like showing in diaper the other day (2) and doctor said could be from lack of or may need more liquids, which is my concern. I did not breast feed my babies so I am not an expert in amounts of breast milk, but I did give my babies at least 3 - 8oz bottles of some type of liquid a day at 9 mos, either skimmed or formula, watered down baby juice or apple juice, or just water until 1 year or older and then introduced the sippy cup and tried to get the whole cup down.
Should he be getting more formula or water if he is not being breastfed much, and if she weens him off of breastfeeding during day and does it only at nite, should he not be increasing liquid intake during day?
-MT
Dear MT: One cannot know for sure how much milk a child is getting based on how long he spends on the breast. After 9 months of nursing the breast becomes very efficient at producing milk so that 10 minutes of nursing may be sufficient to provide more than 8 ounces of milk. Since your grandson is gaining weight adequately and baby food also has a high water content, he is probably getting adequate fluids. One can be more certain that the baby is getting adequate fluids if he is wetting plenty of diapers.
If your grandson's mother cuts down or eliminates nursing she will need to increase his fluid intake by offering formula and other liquids.
Your grandson's sleeping problems are not likely to be related to nutrition or fluid intake. At 9 months he is most likely at the peak of separation anxiety and has not learned to put himself to sleep. I urge you to read my article Helping Your Child to Sleep Through the Night.
Sincerely,
Dr. Warren
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