2 September 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
Thank you very much.
-SW
Dear SW: Your nephew may have a torticollis, a tight muscle in the neck. This may respond to stretching with each diaper change; however, if the baby always has his head turned and tilted to one side, it might be a good idea to see an orthopedist who will prescribe some physical therapy.
Sincerely,
Dr. Warren
-C & H M
Dear Mr. & Mrs. M: Most children are walking by 16 months, but not all do. My two daughters didn't walk until 18 months. It sounds like your son is progressing toward walking and will walk when he is ready, so I would just give him more time.
Sincerely,
Dr. Warren
-T
Dear T: Your description sounds like Herpes gingivostomatitis, an inflammation of the mouth and gums caused by Herpes virus. This illness usually lasts 1 to 2 weeks and will make your son prone to fever blisters in the future. He probably caught it from someone who had an outbreak of fever blisters. Herpes gingivostomatitis can be a miserable illness. You should continue to give your son Tylenol or Motrin for fever and discomfort. The biggest challenge is to get adequate fluids into him to prevent dehydration. Since it hurts to drink you will have to offer the fluids frequently. Ices and ice pops may help the discomfort while providing fluids.
Sincerely,
Dr. Warren
My question is what causes this and what kind of Doctor would you see to find out how to remove it or if you can have it removed? Any information about this or where I could read about it would be greatly appreciated.
Thank you.
-Dawn
Dear Dawn: It sounds like your daughter had an area of aplasia of the skin (lack of skin growth) of the scalp. The knot you describe is scar tissue which has formed to heal the opening. I don't know of any specific cause. I have had two of my own patients with this condition. You should consult a plastic surgeon about removing the scar tissue and closing the scalp. This will still result in a scar, but it should be small enough to be covered more easily with hair.
Sincerely,
Dr. Warren
He was 8 lbs 5 oz when born and 14 lbs 7 oz at 8 weeks so he's not starving. However, the past week has been almost unbearable and we worry that he may be allergic or something.
Help!
-B
Dear B: Your baby may indeed have a formula sensitivity and may improve with a hypoallergenic formula like Alimentum or Nutramigen; however, such a drastic change in a 9 week old's behavior could be related to illness as well, so you should see your pediatrician.
Sincerely,
Dr. Warren
Probably totally unrelated -- she also has terrible "growing pains" at night time, and has a tumor on her lower back on the right hip. She had a MRI when she was three months old and we were told it was a combination lipoma/hematoma (I may haved mixed the words up in the last six years). I'm sure that none of this is related, but am extremely worried she could have something serious and I am not putting all of the symptoms together.
Thank you
-JD - the most paranoid mom ever
Dear JD: Your daughter may have nothing wrong with her at all and may simply have found the right words to get carried. She wouldn't be the first 6 year old who would rather be carried than walk. Since it's unlikely that walking would cause heartburn, especially in a child who doesn't get heartburn any other time, the first step in deciding what to do is to ask her to show you where she has "heartburn" and to describe what she feels. If you have any reason after that to believe she might have real discomfort, have her pediatrician check it out.
Sincerely,
Dr. Warren
Thank you so much for your time.
-Joy
Dear Joy: One very important current issue in pediatrics is emerging strains of bacteria which are resistant to multiple antibiotics. This is being attacked on two fronts, both of which can be considered current trends in pediatrics.
The first trend is to decrease the use of antibiotics. Physicians who use antibiotics for inappropriate reasons have always contributed unnecessarily to antibiotic resistance, but even when antibiotics are used appropriately their use encourages the emergence of resistant strains. Therefore, criteria have been established for appropriate use of antibiotics for treating respiratory infections. Criteria are being established and disseminated for the diagnosis and treatment of sinusitis. Research is being done on treating infections with shorter courses of antibiotics. Research is also being done on shorter courses of treatment for ear infections and establishing criteria for which ear infections do not require antibiotic treatment.
Short courses of antibiotics are also being recommended for uncomplicated urinary tract infections.
The second trend to explore, also related to emerging strains of bacteria resistant to multiple antibiotics, is prevention of infection. Research is underway to develop vaccines which will prevent ear infections, pneumonia, and other infectious diseases. This includes prevention of viral diseases which are not treated with antibiotics. The Rotavirus vaccine was just recently released to prevent Rotavirus disease, the main cause of infectious diarrhea in infants.*
Future pediatric practice will undoubtedly include testing for genetic diseases with an aim toward counseling for prevention or providing genetic treatments. The research is ongoing now, but this is further off in the future.
Check the American Academy of Pediatrics Web site to see if you get any other ideas there.
Sincerely,
Dr. Warren
-R
Dear R: Stool may be malodorous in certain diseases, but if your grandson is otherwise healthy and has had regular checkups, smelly stool alone does not mean anything is wrong.
Sincerely,
Dr. Warren
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