19 July 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
| Son | Daughter |
| 1. poor appetite | |
| 2. crying/fussy | |
| 3. hold ears in sleep | |
| 4. wake up crying | |
| 5. sinuses drain & get blocked | |
| 6. have bad breath | |
| 7. night sweats frequent | |
| 8. son wheezes & can't catch breath | 8. daughter- chest rumbles when breathing |
| 9. son constantly picks his nose | 9. daughter- blue under eyes & sometimes puffy |
| 10. energy level dropping | |
| 11. son sometimes stops breathing for 5 or so seconds and then gasps for breath in sleep | 11. daughter breaths through mouth |
Thank you for your time.
-M
Dear M: If your children's ear infections have not responded to antibiotic treatment for 2-3 months then it is time to seen an ENT specialist. If your son has huge tonsils with sleep apnea that would be another reason to see an ENT. Other symptoms you describe sound like they are allergy and asthma related. You need to coordinate their care with specialist through your pediatrician.
Sincerely,
Dr. Warren
Thank you and please e-mail me back!
-Ashley
P.S.: His father has renal disease and I am worried that this could be a factor in his behavior.
Dear Ashley: I think you're throwing together a whole bunch of different problems and looking for one simple solution. For example, your son's asthma or wheezing doesn't necessarily have anything to do with his screaming, unless he is screaming because he is having difficulty breathing. I'm not sure what you mean when you say the nebulizer isn't working. You need to understand what the nebulizer is supposed to do. Depending on what medications he is getting, he would be taking medications to prevent and/or control wheezing. These medications don't treat colds or fevers. If you say the nebulizer isn't working because your son is experiencing wheezing with difficulty breathing that doesn't clear with a treatment, then he needs more aggressive treatment of his asthma. I think you need to learn a little about asthma so that you know what to expect from his treatment and when to demand further evaluation or a change in treatment. I have several articles you could read about asthma which you can get to from my list of articles. While you're there you should also read my article about Upper Respiratory Infections (URIs) which is the medical term for colds, and my article about antibiotics.
In answer to your question, antibiotics are not useful for treating colds or asthma, nor can they prevent colds from coming back. Colds are infectious illnesses which you get by catching it from someone else. Babies in daycare get more colds because they are exposed to more colds, but that's not serious, so don't let it interfere with your finishing school.
Young infants often have increased difficulty with asthma when they have colds. Complications of colds like ear infections may cause screaming. Just being sick or stuffy may interfere with eating. That's okay when an infant is sick, as long as your pediatrician finds that your son is continuing to gain weight and grow properly.
Your son could be screaming and waking for other reasons including teething, sleep disturbed by coughing or stuffiness, separation anxiety which is a normal part of infancy usually starting between 6 and 8 months.
It sounds like you are a bit overwhelmed by caring for your son when he is ill. It's admirable that you want to take the responsibility, but that doesn't mean going it alone. Isn't there someone (your mother, an aunt, a counselor) who you could talk to regularly about child care just so you can get a better idea of what's normal for a baby and when there's a problem?
Sincerely,
Dr. Warren
-Dodger
Dear Dodger: Why did you wait until the last minute to write to me!?! I hope you read my response before your homework is due. I don't have time to write a whole lot to you now. You should go to the Children's Medical Center of the University of Virginia web site to see their excellent tutorial on asthma. I think it will answer all your questions. You can also look at the articles I've written about asthma. The links to the articles are in my list of articles.
Sincerely,
Dr. Warren
Do you have any idea what this might be??
Please respond as soon as you can
-JM
Dear JM: From your description, I would guess that the lump is a lymph node, but, of course, I cannot be sure since I haven't seen it. Small lymph nodes in children's necks are fairly common due to children's high frequency of upper respiratory infections. If the lump is enlarging, tender, or if your daughter is getting lots of lumps, she should see her pediatrician.
Sincerely,
Dr. Warren
-T & V
Dear T & V: I see no rush to offer infants juice at all except when it is given to help constipation. Human milk or formula are complete food. Juice is certainly not a supplement. The American Academy of Pediatrics doesn't recommend offering any food besides nursing or formula before 4 months.
Excess juice can cause diarrhea. Babies who drink lots of juice decrease their milk intake, which is undesirable since the milk is the baby's source of protein and the best source of complete nutrition for the baby. I don't introduce juice until after I've introduced fruit. Going along with the AAP's recommendations, I don't introduce fruit before 4 months. I recommend offering juice in a cup so that babies get used to a cup since babies don't need lots of juice. That also serves to avoid having the baby start drinking bottles of juice in place of milk.
I generally introduce juice after 6 months, but I don't want to imply that the other doctors' advice was harmful. Babies can tolerate juice from early on. I hope, in my explanation, I've made it clear why it is nutritionally best to wait and introduce it in a cup.
Sincerely,
Dr. Warren
Thanks for your help.
-MF
Dear MF: Nighttime leg cramps in a child who has no limp and no daytime pain or pain interfering with activity is what is usually called growing pains. These are spasms in muscles at rest after a hard day's workout. They respond best to massage. If a muscle is in a knot, have your son slowly stand on his feet to stretch the muscle and relax the cramp.
Sincerely,
Dr. Warren
-KD
Dear KD: Not all behaviors that need to be changed are done maliciously or in anger. While it's true that the circumstances may affect your response to a particular behavior, your understanding that the biting occurs during affection or excitement becomes irrelevant since this behavior is regularly repeated and needs to be changed. There are two aspects to changing any behavior: 1. provide an acceptable substitute behavior, and 2. respond consistently to the undesirable behavior to make it clear that the behavior must change. An extra trick is the preemptive strike. If you sense a bite coming, pull your son away from your self and tell him not to bite, and if possible provide the bite substitute. Your response does not need to be harsh or ruin the moment for you or your son.
I suggest carrying a teething ring or appropriate toy that your son could bite on. When your son bites pull him away from you briefly and tell him firmly but not angrily "Don't bite!" Then tell him, "If you need to bite, bite this." and hand him the object he may bite. You can also tell him "This is what you do with your mouth." and kiss him. Tell him you love him, but you don't like biting. Avoid acting shocked as your son may think it's a game. If he bites intentionally in response to you or to test you, give him a brief time out. When in circumstances where biting often occurs, you may remind him early on not to bite, but don't make a big issue out of it. Respond essentially the same way every time. It could take a long time for him to learn to control his honest but unacceptable impulse.
Sincerely,
Dr. Warren
-Worried Mom
Dear Worried Mom: The color of stool comes from a variety of things including bile which is a normal component of stool. Bile is green. When the contents of the intestines pass through more quickly as happens with diarrhea, the green color is usually more evident, but normal stools can also have a considerable degree of green. Normal stool can be any shade of brown, yellow, or green. It should not be red (blood), gray or white (absence of bile suggesting obstruction of bile flow), or jet black (the color of stool with blood from higher in the intestinal tract). Stool which is very dark but not black does not indicate blood.
Sincerely,
Dr. Warren
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