16 August 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
Thank you very much
-B
Dear B: You've never heard of Milk Worms and couldn't find any information about them because there is nothing officially known as Milk Worms. I never heard of them either, but before I dismissed the term as bogus, I searched the medical literature for it and found nothing.
The term is most likely one used in certain locales or an archaic term that is no longer used. This is, unfortunately, a perfect example of why it is a disservice to patients when doctors provide simplified explanations with inaccurate terms because they think it will be easier for the patient. The end result is that the patient cannot search for additional information and other physicians cannot be sure what the actual condition the doctor diagnosed was.
Sincerely,
Dr. Warren
Could you give me some general guidelines on how to dress her and how I can tell whether he's too hot or cold? Thank you.
Sincerely,
-HR
Dear HR: You should not overdress an infant. Overheating is not any healthier than being chilled. You should dress an infant according to what would be comfortable for the weather. Unless it is hot out, most people include an undershirt, but that depends how heavy the outer clothes are. If your baby has no hair, a light hat can protect her head from the sun, otherwise, a hat is not necessary once it is warm out.
Dressing your infant the way you would dress yourself is probably the most reasonable guide unless you are usually hotter or colder than most other people.
Sincerely,
Dr. Warren
-SS
Dear SS: Most likely your son has reached the point where he doesn't want to stay still for diaper changes. As he has become more active, since the average changing table is high and narrow, you have probably had to restrict his movement more, and so he associates the changing table with being held still. An additional factor may be separation anxiety which starts around 8 months. Usually it doesn't occur right in the presence of the parents, but some kids get hysterical when they get put down. They just want to be held.
If the above explanation does not fit, you would have to see if it is the changing table or the changing process which upsets him. This can be done by trying the change on another surface. Once babies become very active many mothers switch to a changing pad which can be put on a bed or the floor for doing diaper changes.
Sincerely,
Dr. Warren
-JK
Dear JK: You'll have to tell me what MSPI stands for.
Sincerely,
Dr. Warren
-JK
Dear JK: When a child has multiple food intolerances, reading labels on all prepared foods is a must, but even then some ingredients can slip by, so the best bet is to prepare everything yourself from scratch. One trick I recommend for any one who is milk intolerant is to purchase Kosher foods which are marked "pareve." Those will never have any milk products in them. Avoid any foods which have casein, whey, lactalbumin, or lactoglobulin listed as ingredients.
Besides fruits and vegetables, a child who is milk and soy protein intolerant can eat meat, pasta, and most breads and cereals (as long as they aren't made from soy or with milk). Older children can also enjoy nuts and nut products.
While milk is similar from one mammalian species to another, many children who don't tolerate cow's milk do just fine with human milk because the protein is not the same. While human milk is most suited to human babies, a child who is allergic to cow's milk may tolerate milk and milk products from goats. Consult your allergist before trying these.
Sincerely,
Dr. Warren
Thank you
-CH
Dear CH: You could be describing a lymph node. Many infants develop swelling of these nodes with upper respiratory infections. Because children have so many of these infections, sometimes the swollen glands seem to persist indefinitely. During some sore throats and colds, the nodes may swell and become tender. If these are the times that your grandson complains that it is sore, it is probably an inflammatory lymph node. They are nothing to worry about as long as they don't become red, angry, swollen and tender.
Since I haven't examined your grandson, I can't give you the complete reassurance I'd like to. The only one who knows what that lump is is your grandson's pediatrician. I'm sure she felt her reassurance was sufficient, but my experience with patients tells me that when they don't know or understand exactly what their diagnosis is, eventually their worries return. I can only beg my colleagues to give patients accurate information spoken in English rather than Medicalese, but with correct terminology so that patients can look it up themselves. And as for the patients, it is not only their right, but their responsibility to ask questions. Unless your daughter-in-law is satisfied with the reassurance without a diagnosis, she needs to ask the pediatrician what the lump is.
Sincerely,
Dr. Warren
Thank You.
-RG
Dear RG: It is possible that your son has allergies. If you want to try a formula change, you would need to try a hypoallergenic formula like Alimentum or Nutramigen. If that doesn't help, when he is older you might consider an evaluation for allergies. Most young infants don't have allergies to pollens or other inhalants because they haven't had enough exposure to these things to become sensitized.
If your son's nose is stuffed, you should keep a humidifier running and use saline drops in his nose. If he has a constant clear runny nose you will just have to wipe it periodically. I can't recommend keeping such a young child on antihistamines or decongestants since they make infants irritable.
Sincerely,
Dr. Warren
Thanks
-JL
Dear JL: You are referring to a preauricular sinus. I'm not aware of there being any increase in the frequency of this minor anomaly since 1989 nor am I aware of any predilection for a particular race or group of people.
The complex process of organ formation during early fetal life involves cells multiplying and forming tubular structures Most of these tubular structures combine to form specific organs with some of the original tubes disappearing. The facial structures form from tubular arches. In the process, sometimes a tract may be left which didn't close off. The preauricular sinus is only one possible result of this process. Fortunately, it is harmless.
Sincerely,
Dr. Warren
-Leslie
Dear Leslie: One of the most frustrating things for parents in dealing with difficult problems is that they think (or perhaps hope) that following the prescribed treatment will quickly result in a cure. Unfortunately, with stool withholding, that is not the case. Most kids who withhold stool have to have their mineral oil and laxatives increased regularly until the point is reached where it is impossible for them to hold the stool in. This is a long, messy ordeal. Once the correct dose is reached most kids start having more soiling accidents. Then the process of retraining the child first begins. The more resistant child may require the intervention of a psychologist or ongoing management by a pediatric gastroenterologist.
Keeping in mind that this is not a quickly resolved problem, please read, or reread my article, Fecal Soiling. Since your daughter is holding it in and not soiling, you may have overlooked this article thinking it doesn't apply, but since most soiling is a result of stool withholding, you will find a thorough discussion of the subject in this article.
Sincerely,
Dr. Warren
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