25 October 2004

1. No Breathing at Birth
2. Too Old to Become a Pediatrician?
3. Rash from Drooling
4. Small Size, Tan Skin, Odor
5. Worried About Penis Growth
6. In Flight Ear Pain
7. Excess Urination as a Sign of Diabetes
8. Eczema
9. Disclaimer

• Read Questions & Answers in Another Column

No Breathing at Birth

Bye.

-E

Dear E: Brain cells require oxygen as do all body cells. The brain is very sensitive to lack of oxygen. The longer the brain is deprived of oxygen, the more seriously it is damaged. If, during the 5 minutes your newborn was not breathing on his own, he was given oxygen and was resuscitated with artificial respiration (mouth to mouth or with a bag) then he may not suffer any serious consequences. If your son's brain did not receive oxygen for any significant period of time, he will suffer neurological damage.

Sincerely,
Dr. Warren

-RB

Dear RB: When I was in medical school, one of my classmates was a 40 year old man with a wife and kids. A person is never too old to become a physician if he is capable of learning the skills to become a physician. Maturity and life experience may prove to be a major benefit as you work to become a pediatrician. Only you can decide if the current obligations in your life would interfere with making a commitment to becoming a pediatrician. Please ask yourself what you will be doing for the next 11 years and what you will be doing 11 years from now if you don't follow your dream.

Sincerely,
Dr. Warren

Thanks for your time.

-JC

Dear JC: If your daughter is getting a rash from drooling associated with teething the problem is that the constant moisture is removing skin oil resulting in evaporation of water from the lower layers of the skin and drying the skin out. It sounds like a paradox, but too much water dries the skin, unless you protect it and moisturize it. Hydrocortisone cream and Elocon cream will reduce the inflammation in the dry skin, but may dry it further. You need to use a thin layer of Vaseline, or a moisturizing ointment like Aquaphor to protect and moisturize the skin that is constantly wet from saliva.

Sincerely,
Dr. Warren

-Colleen

Dear Colleen: A child with an unusual smell, short stature, and an unexpected tan could have a metabolic disorder. An unusual smell could also come from certain skin conditions, for example, heavy cradle cap sometimes has a slightly rancid smell. Without more details or seeing the child, I cannot say more, but if the child's growth is suboptimal, and if he is getting regular medical care, you would expect his pediatrician to be looking into it. Perhaps there is something going on and the parents are aware of it but have chosen to not share the information with everyone.

Sincerely,
Dr. Warren

Sincerely,
-Aaron

Dear Aaron : I can certainly understand the distress of a 15 year old boy who is concerned about the size and development of his penis; however, depending on where you are in puberty, everything may be perfectly normal and it will be simply a matter of time before your penis starts to grow and reach adult size. Some boys may begin puberty as early as 10 years old. Most start around 12 or 13. But some perfectly normal boys don't start puberty until they are 16! Once puberty begins, it proceeds in a relatively orderly fashion, but until it begins, the genitals remain the same size as during infancy. Young boys can have erections, but ejaculation of sperm does not occur until midway through the changes of puberty.

The first change of puberty is enlargement of the testicles. If that has already happened for you but no other changes have occurred, if you can be patient, I can assure you that everything else will happen. After the testicles grow the next step is the start of pubic hair and growth of the penis. By the time a boy has thick, coarse pubic hair his penis is usually at or near adult size, but sometimes body hair development may outpace genital development.

If you have completed all the changes of puberty (your description of inability to ejaculate makes me doubt that) and your penis has not grown, you would have to consult an endocrinologist to check your hormones and then perhaps a plastic surgeon to discuss your options. I'm quite sure that's not your situation. If you have not started puberty or have early changes of puberty, I would urge you to be patient since everything you want to happen will. If you are extremely distressed by your slow pubertal development (even though it's still normal at 15) you could discuss hormone treatment with your doctor.

Sincerely,
Dr. Warren

Thank you in advance for your response.

-CD

Dear CD: Swallowing opens the Eustachian tube and so helps to equalize pressure changes in the middle ear; therefore feeding an infant during takeoff and landing may prevent or relieve some discomfort. Discomfort associated with pressure changes is aggravated by nasal stuffiness so it can also help to use a nasal decongestant drop like Afrin prior to flight IF a baby is congested. Unfortunately, under the best of circumstances, some people experience discomfort from the gravity forces of takeoff and landing and infants are not known for their tolerance of discomfort; however there is some evidence that sugar water provides some mild analgesia. It's worth a try.

Sincerely,
Dr. Warren

-Scott

Dear Scott: It's hard to quantify what excess urination would be, but since diabetes has to start at some point, most patients can recognize a significant increase in urination. The increase in urination is caused by sugar in the urine. This causes weight loss. If your baby is still growing at the same pace and is healthy, it's unlikely that she could have diabetes; however, testing the urine for sugar is a simple, non-invasive test. Collecting the urine requires putting a bag on the baby, but it may be satisfactory just to put a test strip in the baby's diaper. From what you've told me, I doubt that it's even necessary.

Sincerely,
Dr. Warren

-KJ

Dear KJ: It wasn't clear from the wording of your question whether you had the allergy test done on yourself or your infant. In any event, RAST testing for the most common food allergens can certainly miss some possibilities. Testing for everything would be expensive and require a large volume of blood; therefore tests are generally ordered only on the basis of suspicion for specific allergens. To the best of my knowledge, skin testing is not done for food allergies.

Eczema may occur in response to environmental allergens which cannot be avoided. If possible, it's always best to eliminate the cause of an infants eczema. But whether or not you can eliminate the cause of the eczema the skin requires treatment with moisturizers and anti-inflammatory creams. For mild eczema, you can try ½% or 1% hydrocortisone cream, a moisturizer like Aquaphor ointment, and avoid excess bathing and soap. Severe eczema is not a do-it-yourself project. Treatment requires prescription medicines for which you need to consult your pediatrician or a dermatologist. Keep in mind that treatment will control the eczema but will not cure it. Eczema can be a chronic, recurrent condition which requires ongoing treatment.

Sincerely,
Dr. Warren

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