3 March 2003

1. Feeding Children Who Have an Intestinal Virus
2. Feeding and Constipation
3. Slowing Weight Gain
4. Bell's Palsy
5. SIDS and Home Monitoring
6. Know Your Partner
7. Signs of Teething
8. Dry Skin
9. Disclaimer

• Read Questions & Answers in Another Column

Feeding Children Who Have an Intestinal Virus

Thanks in advance

-AB

Dear AB: Initially, children who have vomiting and diarrhea shouldn't be fed or given anything to drink except electrolyte solution like Pedialyte or Kaolectrolyte. Once the vomiting has come under control, feeding can be started with small amounts of starches like rice, crackers, or toast. Clear soup like chicken broth with starches can be added, for example, chicken noodle soup or chicken and rice soup. Children with diarrhea can be offered the BRAT diet - Bananas, Rice, Apples, Toast - along with clear fluids. Once these are tolerated you can add lean broiled or boiled meat like chicken or turkey. After that you can gradually go back to the regular diet avoiding spicy food and giving small feedings. Within 2 to 3 days the child should be back to the full diet if each of these steps is tolerated.

Sincerely,
Dr. Warren

My son has been on Enfamill, and Good Start..... at 2 mos switched to Prosobee. The reason for the first changes was too much gas, hard tummy, and constant crying, with feet pulling up after feedings. Thus, we figured a lactose intolerance (which I have). Prosobee still has given him bad gas, and since 2 mos he has had really hard to pass stools, usually dry rocks.... or if not that, really formed and dry.... After fooling with kayro (light and dark) and juice (apple) in his bottle's we found that an ounce of applejuice in every bottle at least made him regular. (still hard stools, but at least daily.)

Now, still with much concern, on my part, and after numerous calls to the ped.'s office, they tell me soy formula is not good for him, it constipates..... I'm furious! Why haven't they told me this in previous calls?

I have spoken with the nurse line, WIC nutritionist, and ped. and get conflicting suggestions...... yes water/no water..... syrup/no syrup........

I have an HMO insurance, I want a referral to a ped. GI but the ped. dr. said he wouldn't do that until William is 12 mos, and to try Similac. (which is milk based, right?)

My 3 year old daughter was a by-the-book baby, everything was perfect.....

I have been so frustrated with my son's health, They said it might be colic, too.... I feel, IF he had colic, he's over it now. (his spirit is better) I've used AVENT bottles.... gas drops..... I'm at wits end!!!! I feel bad because I can't help the little guy.....

PLEASE GIVE ME ANY SUGGESTIONS...... and also what solids he should have and what to stay away from....

Thank you EVER-SO MUCH!!!

-AC

Dear AC: Finding the right formula for an infant who appears to have formula intolerance can sometimes be a matter of trial and error. For that reason, I generally go straight to a hypoallergenic formula like Nutramigen or Alimentum. If an infant does well on a hypoallergenic formula, since they are expensive, after a few months we can try other formulas. If lactose intolerance is the primary concern, Lactofree is a milk based formula which has no lactose.

Some infants do get constipated on soy, just as some infants get constipated on the milk based formulas with iron, but to say that soy formula is always constipating as if to suggest that it is never a good choice simply isn't true. Many infants do very well on soy.

Dark Karo syrup was a popular old time remedy for constipation. Since it is a complex sugar which is not fully digested or fully absorbed, it acts like a bulk forming laxative by pulling extra water into the stool. You accomplish the same think by giving fruit juice because of the high concentration of sugar in it. The problem with Karo syrup is, that just like honey, it can have botulism spores and therefore there is a risk of infant botulism. Therefore, just as with honey, infants under two years of age should not get Karo syrup.

Extra water may help constipation to some degree, especially if an infant is not getting enough water, but since most infants meet their fluid needs with their formula or nursing, you probably wouldn't see a big difference. It's okay to give extra water, but large amounts of water could result in the baby's consuming less formula and could cause hyponatremia (low blood sodium) since water has no salts.

Similac is a milk based formula, but your pediatrician may feel that your son's problem was colic rather than lactose intolerance, and therefore consider it worth trying a milk based formula again.

From your description of your son's problem and the description of its management, it doesn't sound like you need to see a specialist at this point. It sounds like you need your pediatrician to sit with you and have an honest discussion of what he thinks is going on, how he would like to manage it, and why.

Since I don't know your son's age, I can't advise you fully on solid feedings. If constipation is a problem, avoid bananas and white rice.

Sincerely,
Dr. Warren

If I wasn't weighing him (I have a scale at home) I wouldn't be worried at all -- he looks chubby and feels great, very alert and playful. He eats frequently and has lots of very wet diapers, and averages about one very poopy diaper each day or so. I'm taking an iron supplement to boost the iron in my breast milk, but am still giving him low-iron formula as he already seems to have problems with constipation. I took him into the pediatrician last week, and the doctor says he looks great and not to worry. But I'm still worried. What's going on to cause this drop off in weight gain?

Thanks!!

-JC

Dear JC: Baby's gain weight because they are growing. It is not our goal for them to get fat. The growth rate doesn't continue up in a straight line through infancy. It slows down. As long as your pediatrician is monitoring your son's growth and finds it to be normal, there is no need to worry about a slow down in your infant's weight gain. It is a normal occurrence in a big baby who is settling on his normal growth curve.

Sincerely,
Dr. Warren

I had never heard of the condition before 2pm this afternoon and feel unsure of what to do or expect, my daughter is chirping if feeling a little shy, because her face looks so strange and I would just like some advice about Bel'ls Palsy and the outlook really.

Hoping you can help,

-DH

Dear DH: Bell's Palsy is usually the result of paralysis of muscles controlled by the seventh cranial nerve. It requires evaluation by a neurologist to determine if it this is the case or if the paralysis is a result of something in the brain. Most people with Bell's Palsy recover completely, but here is no guarantee. Your daughter should be checked for Lyme disease since Lyme may cause Bell's Palsy.

Sincerely,
Dr. Warren

-Erin

Dear Erin: The whole question of whether or not genetics plays a role in SIDS is in flux. For years we believed it ran in families on the basis of a study of a family that had multiple SIDS. A whole industry of evaluation for risk factors and monitoring was born because of that study. A recent reevaluation of that case determined that all the babies were murdered.

SIDS is a frightening prospect because it appears to strike randomly and without warning, but it is also relatively rare. In 22 years as a pediatrician, I have seen only 2 cases of SIDS. One thing you can do to help is to make sure that you put your baby to sleep on his back. That has been shown to reduce the incidence of SIDS.

Home monitoring can become quite an ordeal. Monitors are electronic equipment. They do not work flawlessly. As a general rule they tend to increase parental anxiety because of the constant beeping and false alarms. Unless your doctor feels that there is a reason to monitor your baby, I wouldn't insist on one.

Sincerely,
Dr. Warren

Thank You

-Lonnie

Dear Lonnie: I cannot tell you what the little bumps on your girl's genitals were since I didn't see them. Even if she did have genital warts, I don't know of any treatment that can prevent you from getting them after exposure. One big argument in favor of knowing your sex partner reasonably well before having sex is that no form of protection is foolproof. At this point, you can only know if you are risk by talking to the girl.

Sincerely,
Dr. Warren

My baby sucks her hand vigorously. Could she be teething? If so, how do I best alleviate discomfort?

Looking forward to hearing from you.

-Rene

Dear Rene: Eleven week old babies suck on their hands because they like to suck and they like to put everything in their mouths. Sucking isn't a sign of teething. Teething may begin around 4 months. On average the first tooth comes around 8 months. Teething may cause some discomfort, but unless a baby is irritable from teething, teething requires no special treatment. Just let the baby teethe.

Sincerely,
Dr. Warren

Thank You

-FS

Dear FS: Some people have dry skin just because there are genetic differences among people that make them different, with drier skin being affected by their genetic inheritance. Dry air aggravated by heat during the winter can dry out skin. Soap and excess bathing also dries skin by removing skin oil.

Dry skin should be treated by humidifying the air during the winter, not bathing excessively, using a moisturizing soap like Dove, and using a moisturizer on the skin, especially after bathing.

Sincerely,
Dr. Warren

If your questions haven't been answered here, perhaps you would like to

ask Dr. Warren a question?!?