26 January 2004

1. Tea for Colic?
2. Herpes from the Fountain?
3. Extreme Behavior Requires Professional Help
4. Safety of Medications for Reflux and Hepatitis B Vaccine
5. Vomiting
6. Stomach Trouble
7. Wetting Self with Laughter
8. Blue Hands and Feet
9. Disclaimer

• Read Questions & Answers in Another Column

Tea for Colic?

Thanks!

-Therese

Dear Therese: Some herbal teas such as chamomile purportedly soothe the stomach. I don't know of any studies which establish them to be effective colic treatments. If you do try any teas make sure they are caffeine free and don't try any homemade concoctions which may have toxic ingredients.

Sincerely,
Dr. Warren

Thank you.

-DH

Dear DH: Herpes infections are primarily passed from person to person by direct membrane contact; however, herpes viruses are stable on surfaces for a while, so it is possible it could have spread via a water fountain if the children were putting their lips directly onto the spout. Sharing utensils such as drinking out of the same glass can spread herpes. Your son could have picked it up from someone who had fever blisters. A primary herpes infection will cause blisters throughout the mouth. The recurrences cause fever blisters.

Sincerely,
Dr. Warren

Our son talks in his sleep. Not just every now and then - ALL THE TIME. It is nothing scary as in a nightmare. He is usually talking to his best friend "Isaac" about things that are going on such as "Isaac - come here, you have to see this". He does this almost all night long. He also tosses and turns and rolls. We hate it when he sleeps with us. He will wake us up talking so loudly, sometimes even yelling.

We are wondering if this is keeping him from resting enough and making him tired and "irritable" the next day until he has a nap. If so, is there anything you can do to get a child to quit talking in their sleep? He knows when he throws a tantrum that it is wrong and he apologizes for anything he did during the tantrum once he calms down. If asked, he can tell you exactly what he shouldn't do and if asked what he should do when he gets upset at daycare, he will tell you "Go to the kitchen and calm down".

The daycare director feels we should take him to a counselor, but we feel it is just a normal phase that children go through when they find their anger (except for the sleep talking). I am really against taking our son to a counselor because I really feel I know what they are going to say. Our son is very high spirited and hyper and very friendly. He doesn't listen for long and is very much a leader. I am afraid they would tend to diagnose him with ADD or ADHD (I have had a lot of experience with children and people who have been diagnosed with it) and recommend we put him on Ritalin. I will never do that unless he starts showing more severe symptoms such as not doing well in school, etc. Also, in trying to deal with him regarding his tantrums we have used various forms of discipline. They include grounding him from his favorite things, time out, going to bed after dinner, spanking and not allowing him to go to events he was really looking forward to going to. They have all worked well to some degree and I know counselors nowadays very much look down on spanking.

My husband and I both were raised in families where spanking was a regular part of discipline and believe me, it did both of us good. We would never listen to someone who told us to not spank our child.

Also, my brother-in-law also has a four year old. He started having problems with her about a year ago when her mother left. She was having extremely violent rages. In one episode alone with me she bit me three times kicked me several, spit in my face, hit me. Please understand this was all from asking her to get out of the wet grass so her clothes wouldn't get wet and all I did was pick her up and hold her. When I went to put her in time out, I told her when she calmed down we would talk about it and I shut the door. Within less than five minutes she had destroyed my entire room. Ripping things off shelves, ripping the sheets and comforter off the bed, tearing up books. It was awful!!!! My brother-in-law took her to a counselor and they did developmental testing and they diagnosed her with attachment disorder, but they were very pushy about not spanking, etc. This is why I would rather not take my son to a counselor just yet, at least not until I feel there are more reasons to do so.

Enough of my rambling, I'm sorry to take up so much of your time, but we really are confused by his actions and we are wondering if it could be caused by how much he talks in sleep? I hope you can help by shedding some light on the matter. Thank you.

-KF

Dear KF: There is no "normal phase when children find their anger." Throughout childhood as children mature they progressively improve their ability to delay gratification and control outbursts. Even in that light, your child's outbursts are extreme. Kicking and biting are not a normal or acceptable part of childhood under any circumstances.

ADHD is only one of the disorders that can cause behavioral problems. I understand your concerns, but trained psychologists simply don't hand out the same diagnosis and treatment to everyone who walks through their doors. What's more, you are not obliged to agree to any form of treatment. Additionally, your son's evaluation is confidential and cannot be released to the school without your permission. If you have doubts about the results or recommendations you can get a second opinion. Nobody has to know anything you don't choose to share with them.

In my opinion, your son needs professional help. If he doesn't get it, you will have constant problems with his school. Given your lack of trust in counselors, I think you will have to search for one you can work with. Not all counselors are the same. I do not share your view that spanking works and would urge you to rethink that if it will become an impediment to your seeking counseling. There is no question that a quickly meted out spanking will sometimes put a quick end to a problem behavior temporarily, but as an approach, it has no long term benefits and fosters aggressive behavior. It has not solved your son's problem and may even account for the fact that your son exhibits violent behavior in school which he doesn't exhibit at home.

Your son's sleep disturbance may be contributing to his problem; however, the sleep disturbance may be a result of emotional difficulties. Since your son's behavior is disruptive and a problem in school, he is reinforcing that negative behavior by continuing it. He should have an evaluation by a pediatric neurologist because of the sleep disturbance, but regardless of the results of that evaluation, he needs counseling.

Sincerely,
Dr. Warren

Also, my husband saw a report on 20/20 a couple of weeks ago about some horrible side effects the current Hepatitis B shot was causing infants and will not let me give our son the shot. Have you heard anything about this? Please let me know if you need additional info. I really appreciate your thoughts and opinions.

THANK YOU....

-A frustrated first time mom

Dear Frustrated First Time Mom: You are right to be concerned about using any unnecessary medicine at any age because all medicines can have side effects, but consider how lucky we are to live at a time when there are so many good medications available that weren't around just a few years ago. This affords us the luxury of offering treatments for troubling symptoms. Both Reglan and Zantac are medications which have been used safely and successfully by pediatric gastroenterologists for treating severe gastroesophageal reflux.

I am not in a position to assess the need for these medications for your son since I haven't evaluated him. If you feel that these medications have been prescribed without a thorough investigation of your son's condition, you should consult a pediatric gastroenterologist. In any event, whoever the treating doctor is, you should discuss your treatment options in order to know the risks and benefits of treatment, the alternatives available with their risks and benefits, and the risks of not treating. Armed with this information you can make an informed decision.

With regard to the hepatitis B vaccine, you must keep in mind that 20/20 is a news magazine show. They tend to sensationalize things in order to attract viewers. That doesn't mean that the information they provide is inaccurate, but the same information presented to provide all the facts including an honest comparison to the risks of not being vaccinated might leave you with a different opinion. Anyone who has ever been injured by medical treatment would love to be able to turn back the clock and explore alternatives, but you must remember that just as treatment carries certain risks, so does disease without treatment. Just as preventive measures carry certain risks, doing nothing carries the risk of disease or injury.

Sincerely,
Dr. Warren

-JR

Dear JR: Vomiting can be a symptom of a large variety of illnesses. Since you haven't told me anything else about your child, it's hard for me to advise you. The first thing you should do is proceed with the testing recommended by your doctor since she has seen your child. The second thing is to alter your child's diet to a bland diet with lots of clear fluids. If she is unable to eat without vomiting, you will need to give her an electrolyte solution like Pedialyte or Kaolectrolyte.

Additional evaluation and treatment depends on your daughter's other symptoms. Coughing associated with the vomiting or provoking the vomiting could be seen with asthma, bronchitis, pneumonia, or whooping cough. Diarrhea with vomiting suggests a primary intestinal problem such as gastroenteritis (an intestinal infection). Severe pain with vomiting could be an urgent surgical condition such as appendicitis. Excess urination with vomiting can be seen with diabetes or urinary tract infections. Sore throat with vomiting is not unusual with strep throat. Some children vomit with ear infections.

Follow up with your doctor.

Sincerely,
Dr. Warren

Thanks

-S

Dear S: After three months of symptoms, it's clear that this isn't just an intestinal virus. If you found one food that caused the problem, you could try eliminating it from your diet to see if that helps. Lactose intolerance can develop in somebody who previously had no problem with lactose. It causes bloating, gas, cramps and diarrhea. The symptoms are worst when the lactose intolerant person has milk or yogurt, but may persist between meals and leave the intestines irritable so that symptoms appear to occur with other foods.

Parasites can also cause intermittent and persistent symptoms. Diagnosis, which is needed for treatment, requires testing of a stool specimen.

Inflammatory bowel disease can cause persistent symptoms and can also cause blood in the stool. A proper diagnosis cannot be made without seeing a doctor. These conditions are treatable. After three months of symptoms, it's time to see a doctor.

Sincerely,
Dr. Warren

He had an operation for hypospadias repair when he was 14 months which seemed to work, although we can't be sure whether his wetting himself started after the operation or not.

He has got better at controlling himself over the years, but it is still far from a satisfactory situation. As he gets older, as parents we are getting more concerned.

Any advice would be most appreciated.

-CO

Dear CO: The hypospadius repair should not have anything to do with your son's wetting problem. At age 8, he still has a large number of peers who still wet their beds and who can hope to outgrow the problem. Since his wetting with laughter has improved, that may also resolve, but it is much less common than bed wetting. I suspect that wetting himself with laughter is presenting a problem for your son. It's not as easy to hide as bed wetting. I would consult a urologist to determine if there is a problem which requires or would benefit from intervention.

Sincerely,
Dr. Warren

-TM

Dear TM: Acrocyanosis (blue hands and feet) is common in infants when they are in a cool room. It can be distinguished from cyanosis (generalized blue color) because mucus membranes inside the mouth, lips, and tongue are nice and pink with acrocyanosis. The extremities feel cool to the touch in the blue (purple) areas because those areas have decreased circulation (hence, the color). The decreased circulation to peripheral (not central) parts of the body is one of the ways the body conserves heat. This is not a cause for concern. Neither is it a reason to overdress infants since being overheated is uncomfortable and not good for infants.

Sincerely,
Dr. Warren

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