2 June 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
-JR
Dear JR: Swollen lymph nodes in the neck are very common in response to upper respiratory viruses. It is also not unusual to feel some lymph nodes in the groin. Whether or not to be concerned about any of these depends on how big they are and how they feel to the examining physician. Lymph nodes under the chin can be seen in response to upper respiratory infections, but are less common. Even if the CBC is normal, if the lymph node persists over the next few weeks, it would be reasonable to repeat the CBC and test for mononucleosis.
When a child has an unusual swollen lymph node, it is always important to know about exposure to cats since Cat Scratch disease can cause ominous looking lymph nodes even though it is not a serious condition.
Additional testing really depends on the clinical course of the illness associated with the swollen lymph nodes and the findings on examination. Ultimately, any persisting large or abnormal lymph node must be biopsied to determine its cause.
Sincerely,
Dr. Warren
I received a notice from school that her hearing tested in the "below normal" range, although I have not noticed this at home. Her doctor didn't seem that concerned with the problem after an examination did not reveal any deformity/injury to the ear canal and/or ear drum.
My Question:
Is the body's production of this much ear wax normal?? Could it be
indicative of something more serious?? Other than flushing her ears out, is
there anything else
I should be doing?? Will she ever "outgrow" this?? Or is this just
something that she will have to lear to live with??
Many thanx for your time!
-MP
Dear MP: I don't know of any serious cause of increased cerumen production. Since the ear canals are made of skin, it is possible to have the same skin conditions inside the ear as outside. People with seborrhea of the ear canals often produce an increased amount of oily scale which does not come out of the ear canal as easily as ordinary wax. Putting a few drops of mineral oil in the ears regularly (1-2 times each week) may soften the wax enough to allow it to move outward as ear wax normally does. If there is a lot of inflammation in the ear canal, treatment with a prescription anti-inflammatory drop used for swimmer's ear may help.
People with ear wax problems may have them lifelong; however, I have seen some improve after completion of the changes associated with puberty.
Sincerely,
Dr. Warren
-PB
Dear PB: Babies are born with the ability to see, however color vision develops later. A human face is in focus when a newborn is held for feedings. Since newborns have no knowledge of the outside world, no knowledge of the correct appearance of things or that things exist when they don't see them, newborns makes no attempt to focus. At 2 weeks your daughter is assimilating data, including a huge amount of background data, that you take for granted She is using all her senses and experiences to determine the significance of what she sees. By 6 weeks of age, she will have learned enough to turn her head and watch you when you move away from her.
Sincerely,
Dr. Warren
-LC
Dear LC: An ultrasound of the abdomen and pelvis can look at the ovaries and adrenal glands, both of which produce hormones which could cause breast development. Pigment changes in the skin may suggest an adrenal problem. Clarification of the situation will require blood tests to check various hormone levels and perhaps a consultation with a pediatric endocrinologist.
Sincerely,
Dr. Warren
-Janis
Dear Janis: I seem to be getting a lot of questions about lymph nodes this week which makes me think there must be a virus out there causing a lot of swollen glands. In my own office, I have seen 3 cases of mononucleosis in the past 2 weeks. One was a young man who came to me just for evaluation of a swollen gland (lymph node) with no other symptoms.
You didn't say anything in your query about the size of the node that's worrying you. Swollen glands in the neck are very common in young children because of the high frequency of viral upper respiratory infections. Once these nodes become activated they swell repeatedly every time the child has an upper respiratory infection. Lymph nodes ranging in size from pea sized to lima bean sized may persist for months without being worrisome as long as they are not hard, growing, red and/or tender, or in unusual locations, and as long as there are no other signs of ongoing systemic illness such as fever, irritability, poor appetite, weight loss, cough, etc.
Sincerely,
Dr. Warren
-JR
Dear JR: A vaporizer can be helpful for a cough as can a medication like Robitussin Pediatric Drops. If the cough is severe, you should bring your baby to a pediatrician.
Sincerely,
Dr. Warren
-RD
Dear RD: RSV can cause serious disease. In my career as a pediatrician I have seen one infant with bronchiolitis wheezing so severely that she turned blue and stopped breathing. You are right that most children with RSV don't ever get that sick, but it does happen. The doctors are telling you that the RSV infection provoked the respiratory arrest. You may be right that your daughter is more at risk than the average baby. The doctors may be right that these events won't happen without an inciting cause like the GER or RSV.
Your description of these events takes them clearly outside the realm of infant apnea since those infants respond quickly to stimulation and don't require a major resuscitative effort unless they have already been apneic for some time before they are found. This suggests that your daughter may benefit from home monitoring, and that you may benefit from additional training in resuscitation just in case something about your technique is interfering with rapid success. Unless something is obstructing the airway (which may happen if the head is held in such a way as to crimp the airway) it should not be difficult to get a breath into an infant. If your daughter was wheezing so severely from RSV that it made resuscitation difficult, the question arises as to whether she should have been hospitalized prior to the event.
Sincerely,
Dr. Warren
-AN
Dear AN: Genital warts are contagious. Their spread can be prevented by using condoms. There are no home remedies for genital warts. Moist genital warts such as those on the glans penis and under the foreskin are treated by applying 20% podophyllin resin in compound tincture of benzoin. Warts on the shaft of the penis may not respond as well to podophyllin and may require removal by electrosurgery or cryosurgery.
Sincerely,
Dr. Warren
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