31 March 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
Thanks, any feed back is appreciated.
-KT
Dear KT: Most nursing newborns have a bowel movement after each feeding. Lack of bowel movements could be an indication of a problem. The most immediate possibility is that the baby isn't getting enough milk. Your wife should nurse frequently until her milk comes in fully. This will most likely result in a normal frequency of bowel movements.
If the baby is not urinating, has a distended belly, is irritable, lethargic, feverish, or feeding poorly, contact your pediatrician immediately.
Sincerely,
Dr. Warren
Took her back in 3 days ago, ped said it may be a virus, keep her on regular dosage of Children's Advil to control fever, if not better in 2 days fill prescription for Biaxin and Prednisolone.
She has no appetite and her fluid intake is minimal. We are concerned of dehydration and apparent weight loss. She is running a 103+ fever every 4 hours even with regular dosage of Advil. Ped said to call back by end of week if fever continues, is that too long?? We are thinking of E.R. visit.. Please advise!!
-T & JD
Dear T & JD: Unfortunately, as stated on my Web site, I cannot offer timely enough advice for patients to make urgent decisions. My general advice is that emergency rooms are only appropriate for management of emergencies. When a child has been sick and you have been getting care from a physician, you should stay in touch with the physician. If necessary, insist that he reevaluate your child if you believe she needs to be seen by a doctor. If you are not satisfied with the care you are receiving, find another physician. Your concerns about dehydration are valid. But you should only have to go to an emergency room if you can't get medical care otherwise.
Eight days of fever is longer than the average virus infection and cries out for further evaluation. Fever is not the enemy. Your main concern is what's causing the fever. I don't have enough information to hazard a guess. If the prolonged fever represents more than one illness and the child looks great, waiting a few days is fine. Your description of the situation suggests a need for close monitoring and possibly daily evaluation until the situation is resolved or hospitalization becomes necessary.
Sincerely,
Dr. Warren
Sincerely,
-Cheryl
Dear Cheryl: The test you are referring to is a BAER (brainstem auditory evoked response). I've never seen one done. Even though the child may need to be sedated to sleep, since it is not painful, it should not require general anesthesia. I don't know that a BAER is necessary. At 2 years of age an audiologist who has experience with children should be able to use play conditioning in order to get responses to a soundfield. While this is not an accurate audiogram, it's sufficient to determine if a child has enough hearing in at least one ear to understand and develop speech.
Since a hearing evaluation is only one part of the evaluation for delayed language, you should consult a speech pathologist who can conduct a complete evaluation including a hearing evaluation.
To stimulate speech you should read to your son, talk to him, and repeat words to him. You should never frustrate him in order to correct his speech. If you understand something he says, the positive reinforcement he gets from seeing you respond to his use of language will lay the foundation for his continuing efforts to express himself. Pronunciation can always be corrected after he gets what he wants.
There's only one way to get rid of the pacifier in a kid who won't sleep without it. Get rid of it and be prepared for a few sleepless nights. Once you make that step, DO NOT backtrack.
Sincerely,
Dr. Warren
-WP
Dear WP: I'm not sure that there is a right age to take away a security blanket. As time passes, it's reasonable to try to switch a child's "security" to an age appropriate object such as a doll or stuffed animal. Since blankets are bed items, it's also reasonable to restrict the use of the blanket rather than letting her have it all the time. She can know it's there for her if she really needs it rather than carrying it around.
Sure, cold turkey will get rid of it, but is that really necessary? You'll have to decide based on how you and she handle decreasing her dependence on it .
Sincerely,
Dr. Warren
Please answer My question.
Thank you.
-CP
Dear CP: I can't predict just how much more you will grow. Girls do continue growing after their first period, but their growth does slow down. You may grow another 5 cm, but if your growth in the past year was much less, you can expect that this year's growth will not be more than last year's, and that you are nearing the end of your growth. If you grew 2 or more cm in the past year, then you may continue that for another year or two.
Sincerely,
Dr. Warren
Thanks
-HA
Dear HA: Neither holding a child upside down nor spinning him around should cause brain damage, but of course, it all depends how gently or violently it's done. If the child is happy and enjoying it, it's unlikely it's being done in a harmful manner. If it makes the child unhappy, persistence is cruel and it should be stopped regardless of whether or not there is a risk of injury.
Sincerely,
Dr. Warren
-W
Dear W: The calluses on the palms and soles sometimes have a yellow tinge. If your son isn't yellow any place else, don't give it another thought.
Sincerely,
Dr. Warren
-CR
Dear CR: Wetting could be related to psychological issues. It could also be medical, therefore, your son should have at least a urinalysis and possibly a urine culture. If your son had been staying dry and suddenly started wetting, it would increase the likelihood of there being a medical or psychological cause. If your son has always been wetting himself, it's clear that staying dry just isn't a big enough priority to him to interrupt what he's doing. Stop wasting your breath discussing it with him and simply take him into the bathroom every two hours. If he protests, tell him he can try stopping the scheduled bathroom visits after he hasn't had an accident for two months. You may not have any problem at all getting his cooperation once you get him to the bathroom, but remember, you can't make anything come out of him, so don't end up fighting any battles you can't win. If he does fight you on this matter, whether he uses the toilet or not, continue the every two hour trips to the bathroom until it becomes a routine, unemotional issue.
Sincerely,
Dr. Warren
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