16 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
Another part to this question is that he is uncircumcised and I have noticed that his penis is crooked. The line underneath does not line up with the line in his scrotum and the opening in the foreskin is not verticle but almost completely horizontal. He also seems to have a constant erection. He didn't when he was born but has had one for months now. It is soft but sticks straight up when it used to lie flat. Could this be the source of his troubles? He does not cry when he is diapered or washed.
What should I do? He has seen his doctor countless times (a FP) amd physical assessment reveals nothing. How can I get him to stop crying?
-(unsigned)
Dear Parent: Infants can cry for so many reasons that the job of sleuth has to fall to a physician who can actually examine the child and review the situation. Nonetheless, I will attempt to answer your questions.
If you can provide your own milk by pumping or any other means, it would certainly be worthwhile. Since your son's crying began while he was solely breast fed, I cannot say that is the solution to the problem; however, there may have been factors in your diet which contributed to the problem. These factors may never have been addressed since you introduced formula. If you offer your own milk, make sure you avoid spicy meals and cows milk prior to pumping.
A hypoallergenic formula may not be the answer either, but a trial of Alimentum or Nutramigen can't do any harm and is certainly worthwhile prior to considering a medical workup. Give a formula change at least a week before you expect to see any change. If there is only a small degree of improvement, give it longer since the intestines may need time to fully recover from a reaction to a formula.
The alignment of your son's penis may be perfectly normal. I cannot tell from your description. If he does have a torsion of the penis (rotation around it's axis) this may not cause any future problem and is an issue which can be addressed with a pediatric urologist. Since you describe your son's upright penis as soft, and an erection is not soft, I'm not sure that he actually has an erection. As his body has grown, the relationship of his penis to the pubic fat pad could have changed in such a way as to cause what you are seeing. A constant erection is called priapism. Priapism is painful. I have never heard of it in an infant. Priapism does not occur without a cause. Since you believe your son has a constant erection and he cries a lot, the question of whether or not he has priapism must be evaluated.
Sincerely,
Dr. Warren
-Mrs. A
Dear Mrs. A: I would recommend reevaluation by a pediatric gastroenterologist now that you are in the USA. A normal upper GI series is good news, but it is not sufficient to rule out gastroesophageal reflux. There are a variety of medications which may be used if that is the diagnosis. If your daughter does have reflux, her appetite may be decreased because of inflammation in her esophagus caused by the reflux.
After 5 years of daily vomiting, you need to be aware that even if the vomiting has a medical cause or started due to a medical problem, there may now be a significant behavioral component. Your daughter is used to bringing up food and has developed a negative attitude toward eating. You may need a behavioral therapist to review your approach toward feeding her to see if any changes can be made which will help.
Some children have sweaty hands and feet. The only medical condition which comes to mind which might cause sweating (besides fever from infection or other causes) is hyperthyroidism. Children who are hyperthyroid generally have voracious appetites because of their increased metabolic rate.
Sincerely,
Dr. Warren
-(unsigned)
Dear 16 Year Old: The official English word for cuming is ejaculation. Ejaculation occurs as part of orgasm (the climax of sexual arousal). Some young men do experience a strong enough arousal to come to orgasm just by looking at sexually provocative pictures or as a result of petting even without direct stimulation of the penis. Every erection does not result in ejaculation. Could you imagine what a day in school would be like for you and your friends if you were cuming in your pants every time you got excited!
Since you get erections and have wet dreams (also known as nocturnal emissions) I'm quite certain that your sexual development is normal. Beyond that, you have to understand that even though sexual arousal relates to primal animal instincts, in the human animal, it is very much related to fantasies, feelings, and complex human thought patterns. If you touch your penis to stimulate yourself, you get an erection. If you pull your penis out of your pants to urinate, you don't get an erection, even though you're touching yourself. The difference is in your mind.
This is an important point for you to deal with as you explore the differences between yours and your friends' sexual experiences. If you have been brought up to believe masturbation is wrong, even though you may have a curiosity about it, guilt may prevent you from having a satisfactory experience with masturbation. If you lack privacy, you may not be able to masturbate to climax. Some boys are not at all modest and would have no difficulty having a sexual experience out in the open. Others require a certain amount of privacy. Anxiety can interfere with sexual pleasure. You need to be doing what's right for you.
Not all 16 year olds are at the same point in body development. Not all 16 year olds are at the same place emotionally. And all 16 year olds haven't had the same life experiences. Your dreams and needs may overlap with those of your friends, but they don't have to be the same. This is not a competition, and although I understand your feeling left out, the prize doesn't go to the kid with the first or most sexual experience. My advice: don't rush to do anything you're not ready for.
Dr. Warren: I am sorry to bother you again, but I have one more question to ask you. It's also on the same subject of sexual developement. Well, even though my parents are the only people that really know this, but I am not circumcised. Well, my friend knows also, he isn't circumcised, and he told me, so I don't feel weird not being circumcised. However, it has to do with when I have an erection. I know that you would probably not understand, but you are a doctor, so you might. The skin under the outer layer, is somewhat sensitive. If you touch it, even though I don't mess with it, it sort of hurts a little. This isn't anything big, but I have noticed that when I get an erection, since my penis enlarges, it gets a little bigger than the skin itself, so the head starts to come out. Like I said, it's tender, and sometimes I am afraid, that when the time comes to have sexual intercourse, or oral sex, that it's going to be more painful than pleasurable since that part of my penis, at the head is really sensitive. I don't really know. My friend said that when it happens, you don't have to worry about that, and you won't even notice, because you will be too caught up in the sex itself to worry about a little sting. Maybe you could explain this one for me too. You did a good job explaining my other question, and again, I thank you for responding thoroughly and quickly. So, could you help me on this one too?
-(unsigned)
Dear 16 Year Old: The entire penis, especially the head of the penis has nerve endings which respond to touch for the purpose of sexual stimulation. The area just under the head of the penis where the foreskin attaches to the underside of the penis has the highest concentration of these nerve endings. Stimulation of the area results in a very intense sensation. In the absence of sexual excitation, you may not find the sensation pleasurable, but if you were masturbating or having intercourse, touching those areas would eventually bring you to climax. With sexual experience, including masturbation, you will probably not find the slightest touch to cause such an intense sensation. Circumcised boys are less sensitive because they have lived their whole lives with the area exposed and it has become desensitized by touching diapers and clothing. That area is protected by your foreskin and only becomes exposed if you pull back your foreskin or have an erection. It is normal for the head of the penis to come out of the protection of the foreskin when your penis is erect. During intercourse, the head of the penis will actually move in and out of the foreskin's protection and the foreskin will produce secretions to lubricate it.
Sincerely,
Dr. Warren
Sincerely,
Dr. Warren
Thank you.
-DB
Dear DB: The presence of breast buds in a 6 year old without other signs of pubertal development can just be observed. If there are additional signs of puberty such as pubic hair or acceleration of growth, the child must be evaluated by a pediatric endocrinologist.
Sincerely,
Dr. Warren
-AV
Dear AV: Your son's emotional attachment to nursing is in some ways like an addiction. He takes great comfort from nursing as well as depending on it for sustenance; however, his dependence on it comes from the fact that he simply doesn't know any other way. Because it provides him with so much of what he needs, he resists change; however, without experiencing something else, he cannot learn any other way to be comforted and nourished. There is no simple way to get your son to eat and nurse less. He has to nurse less before he will eat. That means you have to offer your breast less often. If you cannot manage that, you certainly won't be able to wean him. It may be difficult at first, but you have to start sometime.
Sincerely,
Dr. Warren
-BF
Dear BF: There is no reason that a child with vesicoureteral reflux can't be potty trained. If you haven't started yet, it's definitely time to begin.
Sincerely,
Dr. Warren
-BH
Dear BH: Most 7 year olds who still wet the bed will eventually grow out of it. The condition is called enuresis. It is related to the maturation of the nervous system. Since the wetting occurs during sleep, it is not under voluntary control. There are medications which can be used to treat enuresis. You should discuss this with your son's pediatrician. Please read my article, Bed Wetting.
Sincerely,
Dr. Warren
-SB
Dear SB: I am quoting to your directly from my article Upper Respiratory Infections (URIs) which can be found at http://www.mindspring.com/~drwarren/uri.htm.
Even though colds are not serious illnesses newborns have a very hard time dealing with them. Newborns are obligate nose breathers which means that they try to breathe through their noses no matter how stuffed their noses are. Older infants have learned to breathe through their mouths, but they still have an extremely hard time nursing and sleeping when they have colds. Since cold medicines can make infants extremely irritable, the best way to manage infants' cold symptoms is without medication except for the treatment of fever. A vaporizer or cool mist humidifier at the bedside can help relieve nasal stuffiness. Normal saline (salt water) nose drops are also helpful to relieve stuffiness. When the nasal stuffiness is most severe, the best thing to do is to suction the baby's nose with a bulb syringe. The bulb syringe usually has a broad removable tip that looks too big for the baby's nostrils. Before suctioning you should put a drop or two of saline (salt water) nose drops into the nostril. Squeeze the bulb and then insert the tip into the nostril. Pinch both nostrils closed around the tip of the bulb and then slowly release the suction to pull the mucus down from above. When the infant is sleeping, keep the head of the crib slightly elevated by putting a pillow or rolled blanket under the head of the mattress.
Sincerely,
Dr. Warren
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