30 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
Am not positive, but can't a child get a 99.0 from playing outside and being in the sun for a short period of time?
I am also questioning this fact, because she stated that he had a 99.9 temp one day that I went to pick him up. I go him home, took off the long sleeve shirt that he had on (left the undershirt on him) and took his temperature (under the armpit, just as she did). My son had a temperature of 98.4.
Please respond to my question as soon as you have the time to do so. I will be most appreciative.
-JM
Dear JM: Any temperature below 100 degrees F is NOT considered a fever. If the temperature is taken immediately after running around when the child is heavily dressed, it may be elevated, but should return to normal quickly. Since axillary temperatures are 1-2 degrees lower than rectal temperatures, if his axillary temperature was 99.9, his true temperature probably was over 100 degrees F. For more information about fever, please read my article, Fever.
If the teacher is taking temperatures after kids are running around, or just because she thinks a child feels warm, I think you will have to discuss some guidelines with the director of the school. If the temperature was taken because the child was ill in some regard, it becomes a moot point.
Sincerely,
Dr. Warren
Approximately one week after finishing this course of medication she once again developed new areas. The larger areas have never completely healed and are extremely dry. She had began another course of Grifulvin-V this time taking it for approximately 6 to 8 weeks. We are at the half way point in this course of medication and she has had new spots occur while still on the medication. We are going to request that she sees a dermatologist. I would just like to know what your insight is on this.
Thank you very much.
-Denise
Dear Denise: I would agree that you should see a dermatologist unless your pediatrician can do a fungal culture to determine what type of ringworm your child has and what antifungal medications it is sensitive to. In the meanwhile, since your daughter has had multiple outbreaks, you need to look for a source of infection. You can treat ringworm 1000 times with the appropriate medication, and you'll still get more of it if you keep being exposed. Look for exposure to animals such as cats and dogs, other children who may have ringworm, or a toy which may have become contaminated by the ringworm.
Sincerely,
Dr. Warren
-KJO
Dear KJO: Children can have learning disorders without attention deficit disorder. The treatment for learning disorders is strictly educational and does not involve any medication. If your daughter has difficulty concentrating and paying attention, this could also interfere with her learning. Children with learning disorders often do have attention deficit disorder as well. Taking medications like Ritalin helps them to focus on their work so that they can learn more easily. Since Ritalin is a prescription drug, your daughter cannot get it without evaluation by a doctor. Your daughter should have a complete evaluation by the school psychologist. If the evaluation suggests attention deficit disorder, then you will need to take those results and your daughter to a pediatric neurologist or a learning diagnostic center for further evaluation.
Sincerely,
Dr. Warren
Our questions are:
-JC
Dear JC: If your son gets gas no matter what you feed him, he may be swallowing air. This can be helped to some extent by trying a different bottle. The bag bottles like the Playtex Nurser are usually the best in terms of avoiding swallowed air.
Green, loose stools are normal in a newborn. If they are really mucousy, that may not be. Have your pediatrician look at the stool. At 2 months of age, you should be seeing your pediatrician regularly and he should be involved in helping you with this problem. Hearing "gas gurgling in the stomach" does not indicate a problem. There's no such thing as a gas free baby. It doesn't matter how much the baby burps or how much wind he passes. The only issue with gas is how much time the baby spends crying due to gas pains.
If you still think there might be a formula problem, I'd try a hypoallergenic formula like Alimentum or Nutramigen. My first choice would be to get the baby off formula and back on to breast. If your local hospital doesn't have a lactation consultant you can speak to regarding nursing positions, you should contact La Leche League. There are chapters in most major cities. They can also be found on the Web at http://www.lalecheleague.org/.
Sincerely,
Dr. Warren
-TB
Dear TB: Allergy may play a role in the development of otitis media either by contributing to nasal congestion or by directly causing congestion in the middle ear. In the absence of other allergy symptoms, it is unlikely that allergy is the cause of middle ear infections. If allergy plays a role in the development of a child's ear infections, allergy treatment may play a role in preventing these infections. Avoidance of specific allergens is useful if the child can be kept away from them at all times. Allergy shots can take up to a year to show any benefit, so while they may help in the long term, they certainly don't play an immediate role in the management of ear infections. Antihistamines have never been shown to be effective in the management of ear infections.
Allergy treatment and avoidance plays no role in the management of an acute ear infection.
Sincerely,
Dr. Warren
Thanks
-TS
Dear TS: On occasion, the pressure will build up so quickly behind the drum from an ear infection that the drum will rupture, with pus and sometimes blood coming out. Although the rupture is acutely painful, afterward, the pain is immediately relieved. It is just like pus draining from an abscess. A ruptured drum will generally heal without any future consequence. In the days before antibiotics, pediatricians were trained in placing a needle into the drum to drain it to treat an ear infection. A hole in the drum does not significantly affect hearing. In fact, when children have repeated ear infections or persistent middle ear fluid interfering with hearing, the surgical treatment involves placing a tube through the drum in order to keep a hole in the drum open long enough for the middle ear to fully heal.
Sincerely,
Dr. Warren
-DD
Dear DD: If your baby's spooky staring episodes appear to occur as he is drifting off to sleep, or at least when he is tired and not looking at anything, don't worry about them. If they appear to occur at random so that they stop activity, even if briefly, they could be seizures and require further evaluation.
Sincerely,
Dr. Warren
My research on adolescent male breasts has indicated "normal" swelling during puberty but no articles mention firm, painful lumps in males of this age. Can you offer any explanation for this symptom?
Thanks.
-Debra
Dear Debra: The swelling of the male breast from puberty can certainly feel firm and is tender to touch. Initial breast buds in boys and girls feel like lumps. Only well formed breasts feel soft and are clearly defined as breast tissue. The swelling is generally right under the nipple. Without examining your son, I can't state with certainty that this is breast tissue, so if my explanation leaves you with any doubt, you should bring him to his pediatrician.
Sincerely,
Dr. Warren
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