29 September 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
Sincerely,
Dr. Warren
My six year old daughter had delayed speech from chronic ear infections and they both received tubes. He still has his. She received weekly speech therapy for almost 2 years. I don't understand how speech could help him if that is what he may need.
Any suggestions?
Thank you.
-JH
Dear JH: Stuttering involves more than just repeating words. True stuttering involves abnormal breath control during speech with clicks, squeaks, and muscle tension in the neck and face. It is generally a source of anxiety to the stutterer. Stuttering can be helped by speech therapy since the therapist works on the mechanics that cause the stuttering including altering the breathing and muscle tension involved in stuttering.
If your son's speech pattern gets worse, by all means have him evaluated by the speech pathologist. In the meanwhile, make sure you're patient when he speaks. Make sure he knows he has the time he needs to finish a sentence and don't speak for him or complete his sentences.
Sincerely,
Dr. Warren
A response would be greatly appreciated.
- Thanks from Debbie at xxxx@xxx.com
Dear Debbie: The duration of a fever is primarily a concern because most infectious illnesses do not cause fever for longer than a week. If a child is running fever for longer than that, additional diagnostic testing and reevaluation are necessary to be sure no cause of fever was missed or no complication causing fever has developed. For example, children with flu may develop bronchitis, pneumonia, or ear infections which would then cause additional or more prolonged fever.
The longer a child is sick with high fever, the higher the toll on his body including fatigue, loss of appetite, and malaise. The primary risk to prolonged high fever (as long as it is not being caused by any serious illness) is dehydration. Since dehydration will aggravate the fever, it is crucial to make sure that sick kids are drinking.
There is no specific risk of the fever, even after 7 days. Fevers, even up to 104, even persisting for a week, do not harm children (as long as they are drinking). Since there is no treatment which cures fever, the only treatment to be offered is acetaminophen (Tylenol, Feverall) or ibuprofen (Advil, Motrin) for symptomatic relief of fever. The only way to get rid of a fever is to eliminate the cause. Prolonged fevers need reevaluation to determine the cause.
Sincerely,
Dr. Warren
-Beth
Dear Beth: The volume of all words are on the vowels. Try saying the word "pot" and then repeat it without the "o". When you say "p-t" you don't hear much. Certain hard consonants have very little sound. Your daughter's pronunciation of the word "oatmeal" could just represent an immature speech pattern, but it could also reflect the way she hears the word.
If you suspect that your daughter's hearing is affected by middle ear fluid and recurrent ear infections, a consultation with an ENT is appropriate. He can then refer you for a speech and hearing evaluation which would provide useful information to help make a decision about whether or not tubes are needed.
Sincerely,
Dr. Warren
Most of the time, I don't give it much thought - it's not painful or a problem by itself, and it hasn't changed, although the holes appear occasionally. I've chalked it up to my spine extending just a little longer than normal, but I've never had a doctor look at it. I realize your specialty is pediatrics, but I noticed other, similiar articles on your site, so I thought you might have some insight. Thanks for your time.
-C
Dear C: Your description sounds like a pilonidal sinus tract and pilonidal cyst. Pilonidal sinus tracts are small pinhole like openings at the base of the spine which go up into the skin right at the top of the crease between the buttocks. If you have a pilonidal sinus, you were born with it. Sometimes, the tracts may become obstructed and fill with secretions forming a cyst. The pilonidal cyst will then swell and feel hard. Naturally, it is no more comfortable to sit on than if you had taped a pebble there. If the cyst becomes inflamed or infected it becomes more tender and may ooze pus and blood. Recurrent or persistent infection requires surgical treatment.
Sincerely,
Dr. Warren
My second question is about formula itself. There are quite a few different formula's on the market as you must well know, we had started her on isomil but I have been looking at prosobee and also the carnation formula, what kind of difference is there in the content and is one formula any better than the other? The carnation formula seems to be quite a bit less expensive, do you know of any reason not to switch to this brand??
I appreciate any help you could give me!
-Tracy
Dear Tracy: Children who are fussy in infancy when exposed to cow's milk may do just fine with it later on. If the child is lactose intolerant, she may do well with Lactaid milk and other low lactose milk products. If she has milk protein allergy, that could be a life long problem which could prevent her from ever having any cow's milk products including yogurt, cheese, ice cream, and foods prepared with milk.
If your daughter does well on soy formula, she should do well on any brand of soy. I was not aware that Carnation made a soy formula. If the Carnation formula you are referring to is a milk based formula, your daughter could have the same problem with it that she had with Similac.
Sincerely,
Dr. Warren
Thank you in advance.
-Y
Dear Y: According to Dambro: Griffith's 5-Minute Clinical Consult, 1998 ed., Copyright © 1998 Williams & Wilkins,
Familial Mediterranean Fever (FMF) is a hereditary disease transmitted in an autosomal recessive manner, usually occurring in Armenians and Sephardic Jews. Characteristics include short, recurrent attacks of fever with pain in the abdomen, chest, or joints and erythema resembling that seen in erysipelas. It is sometimes complicated by amyloidosis. Attacks of FMF can be prevented by therapy with colchicine. Colchicine therapy also greatly lessens the occurrence of amyloidosis and has resulted in some regression of established amyloidosis. Usual course is intermittent.
The diagnosis is made on clinical grounds as there are no specific tests for it. A positive family history for similar symptoms would be helpful. The diagnosis would require more than fever. Other illnesses which have been referred to as Mediterranean Fever include Rocky Mountain Spotted fever. The symptoms include a rash and blood tests help to confirm the diagnosis. Treatment with appropriate antibiotics is needed. Undulant fever or Brucellosis has also on occasion been referred to as Mediterranean Fever. It is generally seen in adults who are exposed to cattle although it could be passed through infected milk. The diagnosis is confirmed with blood tests and treatment is with appropriate antibiotics.
Sincerely,
Dr. Warren
Please help.
Regards
-M
Dear M: Girls with vaginitis usually complain of discomfort on urination and urinate infrequently because of the discomfort. Frequent, small voids are more characteristic of bladder irritability. Your daughter should have a urinalysis and a urine culture to make sure she does not have a urinary tract infection. If these tests are normal and she continues to have symptoms, she will need further evaluation by a urologist.
Sincerely,
Dr. Warren
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