17 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
The baby never shows any signs of an ear infection, not even a fever. She's never irritable with the ear infections or when teething. She has about 8 teeth and eats mostly solid food since she was about 5 months old. When she drinks out of a bottle, she drinks sitting up. We can't seem to find out why she keeps getting the ear infections, or a way to make them go away once she has them. Is there anything that can be given to her that would help the antibiotic work, or help build her resistance to the infection back up? I have a friend whose child ended up becoming immune to antibiotics and they needed to hospitalize him. I don't want to see this happen to my neice. I would appreciate any feed back that you have. I read several of your articles and I appreciate you doing this service.
-Barbara
Dear Barbara: Children don't become immune to antibiotics. The antibiotics work on bacteria, not on the children. Bacteria can become resistant to antibiotics, but healthy children don't harbor any bacteria in their middle ears, no less resistant bacteria. Even if a child has recurrent ear infections, each new infection is caused by a new group of germs. A child would have to be on a lot of antibiotics to be carrying multiply resistant strains of bacteria in his nose or throat. This is more of an issue in hospitals. If the baby's ear infections don't clear up, she will need the tubes. It is not clear to me why the ENT felt that it wasn't time to do it now.
It is frustrating that you don't always know when the baby has an ear infection, but if she has many of them, you are better off that they don't make her ill. Some children are simply more prone to ear infections because of their facial structure or enlargement of their adenoids. Once an ear infection develops, it can become a vicious cycle of one after another.
Since you have only seen the ENT once, my advice is to continue to have him follow the baby's ears so that he can determine if tubes are necessary and if so what the optimal timing is.
If you have not yet read it, please read my article, Another Ear Infection!?!.
Sincerely,
Dr. Warren
He has had 3 Ct scans, 3 EEG's, Upper GI, Multiple Blood and Urine tests, and an MRI. All the test results were normal. However, his seizures have continued. The other symptoms he has shown are:
-MC
Dear MC: All the discomfort and posturing you are describing could be manifestations of Sandifer syndrome. Stating that your son has reflux is redundant since reflux is part of Sandifer syndrome. Seizures are not part of Sandifer syndrome, so unless your doctors are saying that your son does not have seizures, but rather has cyanotic episodes and seizure like activity as part of his response to reflux, Sandifer syndrome does not explain the whole picture. I think you need to know if that's what his doctors are thinking. If, indeed, all this extreme difficulty can be traced to GE reflux, then, if vigorous medical management does not control the reflux, your son may be a candidate for a surgical approach.
Unfortunately, making diagnoses of complex cases is not something one can do without examining a patient and having access to all tests previously run. With all the normal EEGs and MRI, if your son is developmentally normal, it is unlikely he has a major neurological problem. If the issue of whether or not he has seizures remains unresolved, he should be evaluated with video EEG monitoring. Complex evaluations of this sort and other evaluations for your son's case should be done at a university hospital where specialists can coordinate their diagnostic efforts.
Sincerely,
Dr. Warren
Repectfully,
-Beth
Dear Beth: Milk (human or formula) is very nutritious, so you should relax about the solid foods. The more anxious you become about it, the more your son will resist eating solids. Offer it periodically, but don't push it. Your son has probably responded to multiple episodes of getting a spoon in his mouth when he didn't want it by refusing it altogether. Eventually your son will come around. When he does take something off a spoon, make sure you don't push him or trick him to take more than he wants. If taking milk instead of solids becomes a habit, within the next month or two you may need to decrease the amount of milk you give him to give him an appetite, but first let him learn that the spoon will not make him eat more than he wants. You can control your son's nutrition by controlling what you offer, but he has absolute control over what he takes, and you must respect that.
Since you can't measure your breast milk while you are nursing and there is a large amount of variability in what infants need, as long as your son is growing well, you should assume that your son will take enough to be satisfied rather than aiming for a specific amount.
Sincerely,
Dr. Warren
-(unsigned)
Dear Grandparent: I can't tell you why your grandchild isn't saying much. It's a good sign that he is otherwise developmentally normal and understands spoken language; however, a two-year old should be saying a lot of words and putting words together into phrases. Your grandson needs a complete language evaluation and some early intervention speech/language therapy.
Sincerely,
Dr. Warren
Thank You.
-Deb
Dear Deb: White cells in the urine have nothing to do with any blood disorder, unless there is an abnormality found in the blood. I'm not at all surprised that your daughter didn't have leukemia. I am surprised that it was even mentioned in relationship to white cells in the urine, which makes me wonder if there is something about your daughter's situation that I am misunderstanding.
White cells are pus cells and are present because of infection or inflammation. If your daughter's urinary tract has been evaluated and found to be normal and her urine cultures are always negative, then the white cells must be coming from vaginal secretions. Some girls have a large number of white cells in their vaginal secretions. The white cells in their urine can sometimes be avoided by collecting the urinalysis as a clean catch specimen to begin with. Your pediatrician should check to see if there is vaginal inflammation when your daughter has a large number of white cells in her urine. If your daughter has vaginitis, it can be treated with sitz baths.
Sincerely,
Dr. Warren
-C
Dear C: Pyloric stenosis causes projectile vomiting. Untreated, it will get progressively worse and the infant will not be able to retain any feedings. In some countries antispasmodic mediations have been used to treat pyloric stenosis. In the USA the standard treatment is surgical.
Sincerely,
Dr. Warren
-AC
Dear AC: When infants are sick, they lose their appetites. It will not hurt your baby to go a few days without eating. Your baby's appetite will return when she is feeling better. Just make sure she is drinking adequate fluids so she doesn't become dehydrated.
Sincerely,
Dr. Warren
-BR
Dear BR: I have answered questions about the evaluation of fever of unknown origin on the "Ask Dr. Warren" web site before and ask you to look at those letter for a more complete discussion of the evaluation of FUO.
With regard to your son, 2-4 days of fever each month for 7 months may simply be insignificant viral infections. If your son is doing well and not having any symptoms except these brief fevers, you should just continue to have him checked by his doctor periodically to be sure nothing has been missed. I am assuming your doctor has done some minimal evaluation which, at the very least, should include a urine culture, since urinary tract infection could cause recurrent fever.
Sincerely,
Dr. Warren
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