Ask Dr. Warren ~ The Questions & Their Answers

12 January 2004

  1. Neurofibromatosis
  2. Nursing and Seizure Meds
  3. Toxicity of Clorox
  4. Tracheoesophageal Fistula
  5. Hazards of Peanut Butter
  6. Infant Vomiting
  7. Tummy Ache
  8. Elevated PTT
  9. Disclaimer


Dear Readers:
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

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Dear Dr. Warren: Yes. I was woundering how I could get more information on neurobromoosis? Any help you could give me would be greatly appreciated.

Thank you.


Dear Holly: The following information regarding Neurofibromatosis is from MD Consult Online, Copyright Clinical Reference Systems 1999 Pediatric Advisor. If this is not the condition you are seeking information about, check the spelling and get back to me. This was the closest I could come to neurobromoosis

Neurofibromatosis 1 is also called generalized neurofibromatosis or NF-1. It is a genetic and chronic (ongoing) condition affecting about 1 in 4000 people.

Nearly all children with NF-1 eventually have:

Parts of the body that may be affected include the eye, the bones, and sometimes the blood vessels, gastrointestinal tract, nerves, and brain.
NF-1 is diagnosed when two or more of the following features are present:
Growth and Development
Infants with NF-1 tend to be shorter than average, with heads somewhat larger than average.

When a child with NF-1 is born, he or she may have only the cafe-au-lait spots. The size of the spots varies from 1/4 inch in diameter to several inches. Sometimes newborns have armpit freckling and occasionally neurofibromas.

New cafe-au-lait spots often appear during infancy and early childhood; the spots do not harm your child. As children grow older, the cafe-au-lait spots and neurofibromas tend to increase in number and size. Neurofibromas are particularly prone to increase in size during adolescence and pregnancy.

Neurofibromas may develop in other body organs besides the skin. Sometimes they cause problems, depending on where they develop. Neurofibromas can put pressure on vital structures (for example, blood vessels) and thus do damage to the organs they are pressing on. Neurofibromas need to be removed surgically when they:

For reasons that are not well understood, learning disorders are more common in people with NF-1 than in the general population. Speech problems, hyperactivity, attention problems, seizures, and mental retardation are also somewhat more common. High blood pressure may occur. Some cancers occur in greater than expected rates in persons with NF-1.
Health Care for a Child with Neurofibromatosis
Many doctors care for a child with NF-1. The schedule for well-child visits is the same as for other children, but there are some extra services and care your child needs. The best treatment for neurofibromas is not yet known but many studies are in progress to determine if they can be reduced.

Call Your Child's Physician During Office Hours If:

Additional Resources
The National Neurofibromatosis Foundation (800-323-7938) provides information about medical concerns as well as resources in the community for early detection of problems and support groups. The NNFF web page can be accessed at http://www.nforg/.

A book for parents is:
Medical Publishers, 1990.

Dr. Warren

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Nursing and Seizure Meds

Dear Dr. Warren: I have a question that I would greatly appreciate a reply to. My husband and I will be adopting a newborn and I am very interested in adoptive breastfeeding mainly for bonding reasons. I will be using a supplementer and realize with the baby's sucking it will induce me to produce some milk of my own. My concern is that I am on two medications: Tegretol 800mg daily and Neurontin 1200mg daily. Will this have an ill effect on my baby even though he/she will only be recieving a minimal amount of my milk and it will be diluted with the formula from the supplementer? Thank you so much for your time.


Dear DI: Tegretol is secreted in human milk but the concentrations in the blood of nursing infants is not too high and there have been no reported problems related to nursing while taking Tegretol. Neurontin is a relatively new drug. It is not known whether or not it is secreted in breast milk. No studies have been done regarding the safety of Neurontin in nursing mothers. If the amount of your milk the infant gets is minimal, logic suggests that there shouldn't be any problem, but where there is lack of knowledge and potential for problems, I can only urge caution.

Dr. Warren

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Toxicity of Clorox

Dear Dr. Warren: I'm struggling with this situation and I thought you might could help. If a child drinks a cup of Clorox bleach what would it do to the mouth, esophagus, and stomach? Are there tissues in these areas that would protect them from damage? A classmate of mine claims that Clorox is not really harmful? Could you help me with my question please? I would be very greatful! Thank you.

-a Nursing Student

Dear Nursing Student: Your classmate is correct. According to Ellenhorn's Medical Toxicology, 2nd ed., Copyright 1997 Williams & Wilkins, Most household bleaches (e.g., Clorox) contain less than 5% sodium hypochlorite, which causes a moderate mucosal irritation. This could produce nausea, vomiting, or abdominal pain. It would require a massive ingestion to produce toxicity. The concentration of sodium hypochlorite in Clorox is not high enough to be caustic. Industrial strength bleaches and granules which are a higher concentration could be caustic.

Dr. Warren

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Tracheoesophageal Fistula

Dear Dr. Warren: My four (4) neice (Rosanna) who lives in India has a condition called Tracheo-Oesophageal Fistula. She had a surgery to correct this problem the 2nd day she was born and done several x-rays since then. Till this day she still cannot eat like a normal kid. Her immunity level is really low and she gets sick a lot. Is this problem can be fixed permanently? or she is going to be like this for rest of her life? Is there an organization for kids like this in the United States? My sister-in-law said in her letter there was an organization called TEF Post Operation Club. I searched in the Web, but couldn't find it. Please reply to me as soon as you can.

Thank you so much for your help.


Dear DM: The following information comes from National Organization for Rare Disorders, Inc.(NORD)
55 Kenosia Avenue
PO Box 1968
Danbury, CT 06813-1968

Phone Number: (203) 744-0100
Tollfree: (800) 999-6673 (voicemail only)
TDD Number: (203) 797-9590
Fax Number: (203)798-2291
E-mail Contact:
Home page:

Copyright 1992, 2000

Synonyms of Esophageal Atresia and/or Tracheoesophageal Fistula

* Atresia of Esophagus with or without Tracheoesophageal Fistula
* Esophageal Atresia
* Tracheoesophageal Fistula
* Tracheoesophageal Fistula with or without Esophageal Atresia
General Discussion
Esophageal Atresia and Tracheoesophageal Fistula are disorders of the esophagus that may be inherited as an autosomal recessive genetic trait, or may result from developmental problems in a fetus. Esophageal Atresia is a condition in which the patient is born with an abnormality in the part of the digestive tube that runs from below the tongue to the stomach (esophagus). This disorder is commonly associated with Tracheoesophageal Fistula which is an abnormal tubelike passage between the windpipe and esophagus. Symptoms of these disorders may be excessive about salivation, choking, the return of swallowed food into the mouth, and/or a swollen abdomen when a Tracheoesophageal Fistula is present.
Organizations related to Esophageal Atresia and/or Tracheoesophageal Fistula

Dr. Warren

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Hazards of Peanut Butter

Dear Dr. Warren: I am the father of a 2 year-old and I and others at work am curious about the current instructions to parents about giving children peanut butter. I was told in a class given by the military (when I was still serving) to wait until between 5-7 years of age. Others at work said they were told the minimum is 2 years of age. We all know about the choking hazard of nuts in general for young children. What is in question is peanut butter in particular. Any advice?



Dear Steve: Peanut butter is a choking hazard just like peanuts because it is sticky. Soft bread with peanut butter can easily get caught in the roof of a child's mouth and be difficult for a young child to manipulate. Peanuts are also a potent allergen. Peanut butter carries the same allergy risk as peanuts. It is generally recommended that peanut butter be avoided until a child is at least 2 years old.

Dr. Warren

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Infant Vomiting

Dear Dr. Warren: I read your article on nightime vomiting, but my case is somewhat different. My 5 weekold son has been vomiting off and on for the past 10 days. He has seen his pediatrician which said it was probably a virus or that his throat was somewhat red and there could be drainage from his throat into his stomach. He usually vomits about 30 minutes after a bottle feeding, he first cries like he has stomach cramps. He doesn't throw up after every bottle, just once or twice daily. I have changed his formula to a soy type but he has vomitted it also. I have started him back to his normal formula. He has some diarrhea but it is not very bad. I have been giving him Pedialyte which he seems to keep down. I am worried that it could be something more serious because he is just an infant.



Dear JAM: There are so many possibilities for the 5 week old who appears to be vomiting, that you will need your pediatrician's help to sort it out. As long as the baby is holding down most of his feedings and the vomiting does not escalate in frequency or amount, your son is in no danger. The main risk of vomiting is dehydration. If your son is urinating well and feeding well, you have time to work with your pediatrician to figure this out.

Many babies appear to be vomiting when they are really just spitting. Big spitters may not start out that way because they take small feedings as newborns. As the volume of their feedings increases they start to bring up formula after each feeding, often large amounts with burps and smaller amounts in between. Your pediatrician can help determine if that's what's going on with your baby by following his weight gain and determining if he is thriving.

If the baby starts to have projectile vomiting (vomiting that shoots out forcefully), at 5 weeks you have to think of pyloric stenosis. If the baby is not gaining well, has projectile vomiting and vomiting after most feedings, your pediatrician can get an ultrasound study to look at the pylorus. It might also help for your doctor to observe a feeding and see the vomiting.

If the baby continues to vomit and has a great degree of discomfort, he may be having a significant amount of gastroesophageal reflux. These babies may gain well, but they are irritable from the discomfort and may have coughing or wheezing. If that is the case, an evaluation by a gastroenterologist can help determine if medication would be useful.

Formula sensitivity can cause vomiting. Since soy is not a hypoallergenic formula, it might be better to try the baby on a formula like Nutramigen or Alimentum.

Dr. Warren

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Tummy Ache

Hello Dr. Warren: My 3 month old son has been having tummy aches a couple of times a day for about 3 weeks and watery stool when he has bowel movements about every three days. This is the same amount of time that he's been drinking my breastmilk from a bottle eversince my maternity leave ended and I started back to work.

Before returning to work his stool was full of curds and his bowel movements occured about 5 times a day. I started drinking chamomile tea and hoped that since I'm breastfeeding him, he could somehow feel the stomach calming effects of this tea. I've also been giving him MyIicon drops when his tummy aches occur.

The result is that his tummy aches are less frequent but still occuring and his stool is still completely liquid.

My question is: Do you have any suggestions of anything else I could try?


Dear EPK: From your description, I am not sure that anything unusual is going on. If I understand correctly, your baby is having bowel movements every 3 days. Even if they are watery, since they are infrequent, this does not represent diarrhea. Many nursing babies go from a bowel movement after every feeding to a BM every 3 to 5 days around 3 to 5 months of age. Your baby may just be following the natural course of events which just coincidentally coincide with your return to work. Other factors which may play a role include changes in your diet due to being back at work and swallowed air resulting from bottle feedings. These may be improved by altering your diet and experimenting with different bottles.

It is also possible, with your being back to work, that you brought home an intestinal virus without being too sick yourself. If your baby has an intestinal virus, it is probably on its way to resolution by now. For more information about intestinal viruses, read my article, Management of Gastroenteritis.

Dr. Warren

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Elevated PTT

Greetings: My three year old granddaughter was scheduled for surgery to repair a perforation in her right ear drum caused by several severe ear infections. The ENT also planned to remove her adenoids. We went to get all the pre-op blood work done the week before the surgery. The nurse called and requested a repeat aptt blood test. On the repeat test her "count" was 46. As I understand it, normal range is 24-36. All I know is the numbers indicate a "bleeding problem". I have no idea what this means and haven't been able to get a satisfactory answer. What does it mean? Should we be concerned?


Dear DR: An elevated PTT indicates an abnormality in the normal clotting mechanism such as a deficiency of one of the clotting factors. Your granddaughter should be evaluated by a hematologist prior to having surgery. She may require treatment with clotting factors prior to surgery.

Dr. Warren

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