24 November 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
Is there anything else that I can do to help ease the pain?
-MS
Dear MS: The term growing pains refers to a variety of common muscular pains in growing children related to physical activity. Rapid growth is not painful. Infants may complain for a variety of reasons including teething, gas pains, and separation anxiety. If your son seems to be having a great deal of pain, he should be evaluated by his pediatrician to determine the cause. I am not convinced that a 10 month old has growing pains.
Sincerely,
Dr. Warren
Thanks in advance!
-AG
Dear AG: The main risk to newborns flying is exposure to crowds, and therefore, infectious diseases, in the airport and in the closed space of the airplane. For this reason, I generally recommend avoiding flying with infants before 8 weeks of age.
All infants have a greater risk of ear pain and ear congestion than older children and adults. This can cause pain during flight. Infants have a higher frequency of ear infections than older children. Flying with an ear infection carries the risk of acute pain and rupture of the ear drum. Infants who fly with upper respiratory infections should take a decongestant drop like Neosynephrine or Afrin prior to the flight.
Sincerely,
Dr. Warren
He gets a lot of colds and flu and his immune system seems to be weak. He has had all his vaccinations. His parents don't smoke. We are concerned.
Can you offer any suggestions.
Thank you.
-HG
Dear HG: If a 19 month old spends a lot of time nursing, doesn't eat, and has stopped gaining weight, it is likely he is choosing to nurse when he is hungry rather than eat, and that he is not getting enough milk to sustain his growth. While breast milk is excellent food, it was not intended to continue forever. While there is no need for mother to stop nursing, if you want your son to eat food, he has to spend less time on the breast. A high calorie supplement such as Pediasure may also help to get his weight gain started again.
At 19 months, your son should be having regular checkups which include an assessment of his growth. What does his pediatrician say?
Sincerely,
Dr. Warren
Thank you.
-JG
Dear JG: 10 PM is a late bedtime for a 5 year old, but it is not inherently wrong or harmful. It depends how the child is spending the time and whether or not she sleeps late the next day or gets enough sleep at some point while she is with her father. What is most important is for children to have a routine. When children live in more than one household, it is easier if both households have the same routine, but if the routines are consistent in each household, there's no reason a child can't learn to have one routine at Mom's and another at Dad's. If Dad's schedule is such that the late bedtime on weekends permits him to spend time with his daughter, that precious time warrants a disruption of the regular routine. If the late hours before bed are spent vegetating in front of a TV watching inappropriate material for her age, your daughter would be better off having an earlier bedtime.
You need to assess what, if any, problem the 10 PM bedtime is causing for you and your daughter rather than looking to an arbitrary standard. If there are problems, try to find solutions that all of you can live with. This is not worth turning into a battle with your daughter caught in the middle.
Sincerely,
Dr. Warren
(1) Is this very harmful to the development of brain? Steven is 100% normal now. Will the head grow in a later time?Thanks.(2) Steven did X-ray in last Dec and it is normal. Is it harmful to do second X-ray exam in such a short time?
(3) If CT result also shows normal, what causes his small head and will it a problem for his intelligence in a long term.
-Steven's Dad
Dear Dad: If your son's head is small because your son's head bones are fused and the skull can't grow, this is dangerous to the brain and requires surgical correction. The condition is called craniosynostosis, and the CT scan will tell if that's what's going on.
If your son's head is not growing because his brain is not growing, that's not good either, but then the problem isn't the head size. It's what's going on with the brain. If your son's development is normal, that is an unlikely possibility.
If your son's head is small because your family tends to have small heads, that is just his normal growth pattern. If the CT scan is normal, his natural head size will not affect his intelligence.
Unnecessary x-rays should not be done since the effects of radiation are cumulative over a lifetime, but the dose of radiation in modern x-rays is very low. There is no danger in doing a CT scan now, even if your son had an x-ray 2 months ago.
Sincerely,
Dr. Warren
Thanks.
-Eric
Dear Eric: Lactose intolerance is caused by an inability to digest lactose. It is not an allergy. The symptoms of gas and diarrhea occur after the milk gets into the intestines. Throat swelling and nausea are not symptoms of lactose intolerance. While nausea is not a specific symptom, throat swelling is a serious allergy symptom. If you are allergic to milk protein, you may have no choice but to avoid it for the rest of your life. Consult your doctor about having a RAST test done to see if you are allergic to milk. Since it may not always be possible to avoid milk protein, or even know when you are being exposed to it, you should also discuss the advisability of having emergency treatment for serious allergic reactions with you at all times.
Sincerely,
Dr. Warren
Thank you so much.
Sincerely,
-LR
Dear LR: There is no standard length of time that a child remains lactose intolerant after a bout of gastroenteritis. The more severe the intestinal virus symptoms, the more damage it does to the intestinal lining, and so the more severe and persistent the lactose intolerance will be. Lactose is not digested in the stomach. It is digested in the lower intestines. The symptoms of lactose intolerance include gas, abdominal pain, and diarrhea. Vomiting may occur in response to the cramping, but if it occurs immediately after the feeding, it is more likely due to the stomach still being upset by the virus rather than lactose intolerance.
Most patients are fully recovered from an intestinal virus within a week, but sometimes symptoms, including cramping, can persist two weeks or more. The soy formula is unlikely to be causing cramping, but in the unlikely event that even the soy is contributing to symptoms, you could try a hypoallergenic formula like Alimentum or Nutramigen. You could also try going back to your son's regular formula, but there is no rush to do so. I cannot predict whether he will be symptomatically better or worse on his regular formula.
If your son is ill with high fever, has persisting diarrhea, or has blood in the stool, you doctor should do a stool culture to check for bacterial infections. While gastroenteritis can be a frustrating illness, as long as your child remains well hydrated, he is in no danger, and the illness will pass. If it persists and the stool cultures are negative, then you should consult a gastroenterologist.
Sincerely,
Dr. Warren
-SR
Dear SR: There are many reasons why a child may vomit. The CT scan and endoscopy scheduled for next week may provide some answers. The foul smell of your daughter's breath could be related to the vomiting. She may have acetone on her breath from vomiting a lot. If that's the case, she should also be checked for diabetes which can cause vomiting and acetone on the breath. Since your daughter had enlarged adenoids and chronic ear problems, she may have a sinus infection which could cause bad breath and vomiting. The bad breath could be caused by debris in the crypts of your daughter's tongue aggravated by the vomiting. If so, cleaning the tongue would help.
Sincerely,
Dr. Warren
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