3 February 2003
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
-AL
Dear AL: You present a child who may be having seizures. Your question, then, is should she be evaluated now, or is it reasonable to wait as your pediatrician has suggested. The answer is, "It depends." When I am presented with a scenario such as yours I often ask the parents to videotape it for me. If I can see what the parent is talking about, I have a better idea of whether or not the event could possibly be a seizure.Why not evaluate your daughter right away? From your description of the questionable events as well as the little you've told me about your daughter's daily life, it sounds like she's in no immediate danger. The approach your pediatrician has recommended may help you see if there is a need for further evaluation without doing any costly and possibly frightening tests. Pediatricians tend to avoid procedures unless they are clearly indicated because young children do so many things that cannot always be explained, most of which are not related to medical problems. A period of directed observation ( the doctor tells the parents what to look for and asks for events and certain surrounding circumstances to be written in a log) can often safely help determine what evaluation is needed and may even provide vital diagnostic information.
Why evaluate your daughter right away? Other than the cost of a consultation, a visit to a neurologist will not hurt your daughter; however, unless he can clearly tell from your description (a video could be invaluable) he will have to do some testing. Of course, if your child has a seizure disorder, the same testing will have to be done which would probably include an EEG, CT scan or MRI of the brain, and some blood tests. The imaging studies may require sedation or anesthesia.
Even though an evaluation involves some expense, discomfort, and sometimes some risk, it may be wise for your pediatrician to refer you now. If you are extremely anxious you may not find his "wait and see" attitude comforting, and may not feel that he is acting in your best interest. His reassurances may come across as cavalier, lack of concern, lack of interest, or even ignorance of what is the next best step.
In spite of how aware I am of these issues, I have disappointed patients who felt that I should have taken action immediately. If they consulted another physician because they didn't agree with waiting and ultimately some problem was found, they would conclude I'd missed the diagnosis. I have also had patients who responded to my suggestion that we proceed with further evaluation in questionable situation by asking, "Do we really have to do it now? Can't we wait and see what happens?"
If you are uncomfortable with waiting, explain how you feel to your pediatrician and ask him for a referral to a pediatric neurologist.
Sincerely,
Dr. Warren
-A
Dear A: Milk is complete food for growth at any age since it contains plenty of protein, and the necessary amount of fat, and has adequate carbohydrate for energy. Milk does not meet all possible nutritional needs, but formula has vitamins and minerals added to it. Formula does lack fiber which becomes important for normal intestinal function.
You don't need to worry that your son will become malnourished as long as he is eating enough formula to continue gaining weight adequately. He may prefer the bottles for a variety of reasons such as teething or a need for sucking. However, feeding him all that formula may become a habit, and here is where it becomes difficult to make a change. While I don't advocate starving your child, he won't be hungry for food if he constantly fills up on bottles. Whatever his reason for having given up on food, you have to try periodically to not give him bottles in place of the food he refuses or he may continue to live on bottles.
Even though your son is young and may not be ready to eat your food, it would be helpful for him to experience mealtime by sitting in his highchair with you when the rest of the family eats. Let him start to associate food with a pleasant circumstance just as he associates his bottles with comfort.
Sincerely,
Dr. Warren
Thank you.
(We learned this via the Red Cross when the three of us went to give blood)
-KL
Dear KL: Many genetic traits like blood type are controlled by two genes. Since the A blood type is a dominant trait, both you and your husband may be A+ with only one gene for type A with the second gene for type O. If neither of you contributed an A gene to your son (i.e., both of you gave him your O gene), his blood type would be O.
Sincerely,
Dr. Warren
Yours truly,
-JM
Dear JM: While celiac disease and cystic fibrosis may have some intestinal symptoms in common they are two very different diseases. I cannot fathom why the doctor would not do a sweat test if he seriously considers that a possibility. Since your doctor doesn't wish to refer you elsewhere have him call the specialist you are seeing and arrange for the testing to be done or give you an explanation of why it isn't necessary and what the plan is for coming to a diagnosis and treatment plan. Dealing with all the HMOs in the USA is plenty of hassle, but I have no experience with government run health care, so I don't know what your options are. If your doctor does not provide this minimum of basic care for a sick child, I suggest you contact the appropriate authorities to find out what your options are.
Sincerely,
Dr. Warren
It is easier to poddy on the move in his diaper, I understand but...
Can you help me?
Thanks
-GV
Dear GV: I understand that the ultimate goal of toilet training is independent use of the bathroom with no accidents, but you may be expecting too much from your 3 year old. Staying clean and dry has to become a habit. Your son is used to making a mess, so it doesn't bother him. The only reason he cares at all about it is that you care. If you have to take him to the bathroom regularly in order for him to stay dry, then do just that until it becomes a habit and he has forgotten how it feels to wear diapers and wet himself. Please read my articles Potty Training, and Fecal Soiling.
Sincerely,
Dr. Warren
-Vicki
Dear Vicki: An asthmatic's entire respiratory tract is often more reactive than a non asthmatics. As a result asthmatics' colds often seem worse. Add to that, that they wheeze when they have a cold, and even a minor cold doesn't go unnoticed. But whether a person has asthma or not, the only way he can catch a cold is to be exposed to it, therefore, your son must be expose d each time he catches a cold.
Sincerely,
Dr. Warren
She is on several medications and has several health problems. She has hydrocephalus and has a shunt. For this condition she takes Dilantin to prevent seizures. She also has Cystic Fibrosis and takes enzymes, Zantac, and ADEKs. These meds have not caused any type of reaction in the past, so I am unsure whether it might be the meds or some other condition. Any suggestions you may provide would be appreciated.
-BS
Dear BS: Without a more detailed description, the only thing I can say is that an enlarging swelling in the genital area may be a hernia. Your daughter should be checked by her pediatrician.
Sincerely,
Dr. Warren
Please let me know what you think. It is very important to me.
Thank you very much!
-SM
Dear SM: My literature search did not find any studies linking erythroblastosis fetalis to learning disabilities or ADHD. This could mean that the matter wasn't studied, or that the statistical association wasn't high enough for anyone to pursue the matter and publish a study. There is a potential theoretical link which depends on how severely affected your son was. The brain is highly dependent on oxygen and glucose. If your son developed a profound enough anemia from the erythroblastosis to decrease the oxygen carrying capacity of his blood, or if he was edematous and required intensive care for a variety of associated ills, it certainly could have served as a risk factor to developing his current problems.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
