11 October 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
-K & K R
Dear Mr. & Mrs. R: If your son's recurrent ear infections have generally been associated with upper respiratory infections (colds), then getting him out of daycare where he is constantly exposed to these infections may be the only way to break the cycle.
Most children in this situation do much better after they have tubes, but some continue to have ear infections in spite of the tubes. A child who has an ear infection with drainage through the tubes can be treated with a new ear drop called Floxin rather than antibiotics by mouth. This helps to decrease the child's exposure to systemic antibiotics. Children with difficult to treat and recurrent ear infections may have ear infections which don't respond well to the usual antibiotics; however, children don't become resistant to antibiotics. Only germs become resistant to antibiotics. All of us are at increased risk for exposure to resistant germs when antibiotics are used, so decreasing the use of antibiotics benefits us all.
Children who have recurrent ear infections without other unusual infections generally don't have any problems with their immunity. Throwing in a bout of pneumonia may increase the likelihood that there is an immune deficit in the picture, but if your child is generally healthy except for the ear infections a problem with immunity is unlikely. Your pediatrician should review your child's infection history and growth to determine if there is a reason to consider further evaluation of your child's immune system.
Most ENTs do take care of a large number of children so it is rare that I feel that consulting a pediatric ENT is necessary. However, when a child has had a persistent problem under the care of one physician for a long time, it may be beneficial or at least provide some peace of mind to get a second opinion. I have no quarrel with your ENT's management of your son's ears, but if you desire a second opinion, you might as well consult a pediatric ENT.
Sincerely,
Dr. Warren
Thank You.
-SN
Dear SN: Green stools are not a sign of anything serious. The stress of the move or a change in diet may have caused your children's bowel habits to change temporarily. If they should have persistent diarrhea or abdominal pain, then you should see your pediatrician. Otherwise, I expect their bowels will return to normal in a short while.
Sincerely,
Dr. Warren
Thanks.
-DR
Dear DR: Breast cancer does not usually present with pain or tenderness; however, men can get breast cancer, and there is no situation where it would be normal for a 33 year old man to have a persistently tender or swollen nipple. If either the swelling or tenderness persists, or you feel a lump in your breast which persists, you should see a doctor.
Sincerely,
Dr. Warren
Thank you.
-Scott
Dear Scott: The most common reason that an infant has recurrent thrush is that the previous treatment did not fully eradicate the thrush. Thrush is caused by a yeast. Since it is a living organism, if any thrush remains after treatment, it will grow back. The usual treatment, Nystatin, must be applied directly to all the white spots to work. In difficult cases, Diflucan, a systemic antifungal, may be more effective.
As infants get older, their immune systems become more effective at fighting thrush and they tend to put less things in their mouths, so the problem of recurrent thrush usually improves; however, at 5 months of age, if your daughter is healthy, there is no reason to entertain an unusual diagnosis as a cause for the recurrent thrush. True, antibiotic use, diabetes, and immune deficits would all increase the risk of thrush and the difficulty getting rid of it, but a healthy, normal 5 month old can certainly have thrush.
Diabetes is a serious illness in infants. Thrush would be the least of a diabetic infant's problems. Excess urination, weight loss, vomiting, and dehydration would quickly make an undiagnosed, untreated infant diabetic seriously ill. If your doctor believes that diabetes is a real possibility she would be remiss in waiting to evaluate. My hope is that you misunderstood, and that your pediatrician felt that your baby did not have any potentially serious problems but might be concerned enough to look further if the thrush persisted beyond 9 months of age.
Sincerely,
Dr. Warren
Please advise!
-BC
Dear BC: Obese children tend to be bigger than their peers because their overnutrition accelerates their growth. Many of these children also enter puberty earlier because of the acceleration caused by overnutrition. Early puberty can result in early cessation of growth with a final height less than predicted.
Big children are not all obese or overnourished. There are many factors which contribute to size with genetics being the main factor and general health and nutrition being next. Timing of puberty plays a significant role in the final height and is largely under genetic control. Between the ages of 11 and 13, some of the bigger kids are tall because they've already started their adolescent growth spurt. Those same children will stop growing sooner than their shorter peers who haven't yet entered puberty. As a result some of those children will actually end up shorter than their peers. Those who finish growing unusually early are likely to be short as adults.
The above scenarios do not apply to children who are large in infancy and early childhood. Family growth patterns are the most reliable predictor of how a child will grow. If the big people in your family were also large as children, it is likely that your son is following in their footsteps.
I've explained some reasons why big children may not become big adults, but many big children do become big adults primarily because they are genetically programmed to grow big. It would not be valid to conclude that big children end up as small adults. It only happens under certain circumstances.
Sincerely,
Dr. Warren
-J
Dear J: Breast engorgement can occur as a normal part of puberty. This is called adolescent gynecomastia. If both boys are in puberty, it is normal and will generally resolve on its own. Ten years old is fairly young to see adolescent gynecomastia, but it isn't abnormal as long as the 10 year old is in puberty; however, if your 10 year old has not started any body changes, he should not have breast enlargement and would need further evaluation.
If you have noticed the breast enlargement, chances are, so have your sons. While they may be somewhat embarrassed to talk about it, they are probably embarrassed about it without talking about it, yet don't have the benefit of knowing what it is. You should always express any concerns you have about the boys' bodies to the boys pediatrician, even if you need to call him and discuss it privately before a doctor visit. An examination and discussion of the subject may not only put your mind at ease, but may also help the boys to deal with a concern they've been reluctant to discuss.
If you check the old Ask Dr. Warren columns, you will find several letters on this subject which may further enhance your understanding.
Sincerely,
Dr. Warren
Thank you.
-Debbie
Dear Debbie: There are many things which can help in treating constipation. It is hard for me to advise you because I don't know what you've tried. There are two main pieces of advice I would give anyone with constipation.
In the case of children, let's not forget the importance of insisting that they sit on the toilet long enough to get the job done. Some children don't have the patience to sit and work to have a bowel movement and often only eliminate the part that demands to be let out, the tip of the iceberg. I cured one boy of constipation by telling him to bring his GameBoy into the bathroom with him.
Sincerely,
Dr. Warren
She was unaware that Prosobee contained flouride, therefore since her daughter wasn't able to drink the tap water, wanted to be sure the baby got flouride to ensure healthy teeth. Please let me know your findings. I will really appreciate it.
Thanking you in advance.
-Jackie
Dear Jackie: Prosobee does NOT contain fluoride. Fluoride is not an ingredient in any infant formulas. The caution about mixing the formula with fluoridated water is a result of the fact that if fluoridated water is used to make formula, then infants will be getting fluoride with their formula. The current recommendation is to not start fluoride supplementation prior to 6 month of age. Excess fluoride is bad for the teeth. Giving the correct amount of fluoride helps prevent cavities. In any event, the fluoride would not be the cause of the blood in the infant's stool.
Sincerely,
Dr. Warren
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