7 June 2004
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
Please help me with this problem. Me and my husband have tried everything including many arguements. I would seek the advice of another pediatrician but, I live in a small town. The group of pediatricians my son sees is the only group in town. Please help I feel like you may be our last hope.
-SH
Dear SH: From your e-mail, I'm not sure who is arguing - you with your husband, or you and your husband with your son - but I can assure you that good eating habits never develop in the middle of a battle about food. The first thing you and your husband need to do is educate yourself about child nutrition so that you can approach the problem without a lot of misconceptions creating unnecessary anxiety. Please read my article, Nutrition Without Tears. As you read the article, keep in mind that while hamburger may not be your idea of perfect food (especially with today's health consciousness about fat and other nutrients), it is an excellent source of protein, the basic building block for growth, and fat to provide calories. The pancakes are an excellent source of complex carbohydrates for energy.
You can make up for some of your son's nutritional deficiencies caused by lack of balance in his diet by providing a vitamin and mineral supplement. Since your son's diet is lacking, you should limit the amount of junk food he eats and make it clear that junk food won't be a substitute for meals. Don't argue with your son about it. Make a rule and enforce it. Provide a variety of good foods at mealtime making sure to include the things your son likes on a regular basis, but don't provide hamburger or pancakes at every meal. Make mealtime pleasant. Don't discuss your son's eating, but do make mealtime last at least a certain minimum length of time during which your son should sit at the table whether he eats or not. Also decide on a maximum time for the meal after which, if your son is not eating or is dragging out the meal, the meal is over. When mealtime is over, if your son has not eaten, do not feed him until the next meal. If you believe he is hungry between meals, you may offer one healthy snack, but do not turn it into a marathon trying to get him to eat. If he doesn't eat, he'll have another chance at the next meal.
As to your son's lack of growth and his bowel habits. At 30 pounds your son's weight is at the 25th percentile which is quite respectable. Since he is eating enough calories for his weight to be in the 25th percentile and he has a source of protein, he should be growing. 34 inches is well below the 3rd percentile. Lack of growth may be contributing to your son's poor appetite. Your son need's a medical evaluation to determine why he isn't growing. Considering that he is constipated, he should certainly be checked for hypothyroidism. In addition, your son's constipation may be contributing to poor appetite. If you can't get your son to eat a diet that will improve his constipation, then the constipation should be approached medically using stool softeners, lubricants, bulk formers, and if necessary, mild laxatives.
I see no reason why your baby should learn his eating habits from his brother, but it's premature to worry about that now since there are things you can and should do regarding your 3 year old.
Sincerely,
Dr. Warren
Thankyou.
-Andrea
Dear Andrea: Biting is a very difficult behavior to deal with, especially because most parents feel the problem must be eliminated urgently. It's hard to look the other mothers in the eye when your kid is the one who's biting. They all expect you to put it to a stop instantly.
Unfortunately, there is no quick fix. Your child is responding to an aggressive impulse which, at 19 months, he doesn't have the ability to control. Since you know he does it, you have to be prepared to step in before it happens and prevent the biting when possible. The reality is, you'll be lucky if you prevent it 50% of the time. When your son does bite, your response has to be swift and consistent so that your son learns what to expect and internalizes your response into self control.
Each time your son bites you must immediately remove him from the group and tell him that biting is bad and you won't permit it. Don't tell him he is bad, and avoid the temptation to respond to his aggression by spanking or some other aggressive act as that provides a confusing mixed message. Put your son in time out long enough to get the message and to calm down. When you return him to the group be prepared to remove him immediately if he returns to the same battle. If necessary, don't permit him to return to play with the other children for the remainder of the day. Respond the exact same way every time he bites. That way he will learn.
Sincerely,
Dr. Warren
Thank you very much Doctor.
-AE
Dear AE: Sexuality and sensuality are an innate part of the human condition and are definitely present during childhood. Some children have more of an interest in sexual stimulation than others and may even seek it, but all children presented with a sexual situation are likely to have some interest. However, since children do not generally understand sexuality and are not ready to deal with the associated emotions, it is up to adults to shield them from unnecessary sexual stimulation.
This does not mean that I think you should make a big fuss about any exposure your son has to sexual material. Overzealous enforcement of taboos may just stimulate his interest in the forbidden. You are wise to want to help him have a healthy attitude toward sexuality. When he tells you about an erection it is appropriate to reassure him that it is a normal response. But it is clear that your son is aware of sexual content around him; therefore it is reasonable for you to limit his exposure to sensual material by not watching it in his presence. If he has access to material that is too sexually stimulating for him (TV channels with mature movies, etc.) even though it may be perfectly acceptable and not pornographic materials, you would be wise to install child controls on your television. If you do turn off material which he has somehow gotten to watch which you feel is too stimulating for him, simply tell him that he is too young to watch it. In this world there are lots of things that adults do which are not meant for children. It's a fact of life he has no choice but to accept. It's in his interest for you to set and enforce limits in all aspects of his life.
It's also wise not to go to extremes. If your son gets an erection from seeing a simple kiss in a movie, that doesn't mean he should be precluded from seeing any kisses. Now that you are aware that he pays attention to sexual content around him, you have to decide what is age appropriate for him and what is not.
Sincerely,
Dr. Warren
-JS
Dear JS: Small items pass out of the intestines in the stool without any difficulty. An item made of thin rubber may be partially digested and mixed into stool in such a way as to pass out unnoticed. If the item were to get hung up in the intestines it would cause cramping and eventually vomiting.
In studies done on prison populations who will try swallowing just about anything in order to get to the infirmary or out of the prison ward, inmates have passed items like forks and razor blades without major incident.
Sincerely,
Dr. Warren
-Gina
Dear Gina: I cannot think of any condition That fits your description. There are situations in which an infant's head may be asymmetrical. Some babies develop flattening of one part of the head from lying on the same spot all the time. This tends to be worse if the baby has a tight neck muscle which results in restriction of the baby's head movement or a preference for keeping the head turned one way. There are special helmets which are supposed to reshape the head.
Craniosynostosis, premature closure of one of the growth lines of the skull, can also cause a misshapen skull. This requires surgical treatment, therefore, it is important to accurately distinguish which of the two conditions an infant has.
Sincerely,
Dr. Warren
Thanks so much for any help you may give.
-Linda
Dear Linda: It is not unusual for an 8 month old to develop sleeping problems due to separation anxiety. It is perfectly reasonable to try to comfort and soothe your baby when he cries out for you, but it would be a mistake not to continue putting him into his crib awake. Separation anxiety is a natural outgrowth of a child's developing recognition and understanding of who his mother is and the fact that some people are strangers (not mother). He needs to learn that he can sleep in his crib without you there and that each day you will return to him. He cannot learn that without experiencing it.
It is no accident that you find your baby's cry difficult to listen to. A baby's cry was designed to tear at his mother's heart and get action. However, even though separation anxiety has resulted in your baby's crying out with the urgent belief that he must have you at his side at all times, you can distinguish between his separation anxiety and a truly urgent need for your intervention. In the grand scheme of things, 15 minutes is not a long time for an infant to cry.
Please read my article, Helping Your child to Sleep Through the Night.
Sincerely,
Dr. Warren
-A
Dear A: Abdominal pain, even severe pain, could be something as simple and benign as gas pains with constipation. But, if you're feeling it into your back and it is frequent or constant, you could be talking about kidney stones or gall stones. If you're getting nausea and the pain moves down to the right lower part of your belly, you could be talking about appendicitis. Without more information or examining you, I cannot tell you what it is or if it's serious, but "one of the worst pains you've ever felt" is not meant to be ignored.
I know that you're used to having your Dad take care of any medical concerns you have, but at 14 years of age, you're not equipped to decide how urgent your symptoms are. Based on what you've told me, you ought to be checked by a doctor. In your Dad's absence, you need to tell your Mom or whatever adult is taking care of you about your pain. Do it now.
Sincerely,
Dr. Warren
-Julie
Dear Julie: It is not unusual for healthy children to have a large number of upper respiratory infections (colds) when they first enter daycare, but recurrent pneumonia suggests an underlying problem. Asthma could certainly contribute to recurrent pneumonia and allergies can aggravate asthma. Allergies alone would not cause pneumonia or fever.
Before your daughter undergoes a major medical evaluation for recurrent pneumonia, it would be important to document that she indeed has pneumonia. Coughs and colds with fever are not the same thing as pneumonia. If your daughter has not had a chest x-ray, she should have one. If an x-ray showed pneumonia, she will need a follow up x-ray to demonstrate complete clearing.
If your daughter's recurrent respiratory infections have indeed been pneumonia, then you should consult a pediatric pulmonologist for further evaluation and management.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
