27 December 2004

1. Child with Extreme Fear of Men, Twitching Legs
2. Contagion of Roseola
3. Fever and Sweats
4. Too Much Milk
5. Safety of Chickenpox Vaccine
6. Bed Wetting and Rash
7. Rashes Must be Seen to be Diagnosed
8. Cord Around the Neck
9. Disclaimer

• Read Questions & Answers in Another Column

Child with Extreme Fear of men, Twitching Legs

Question 1:

Question 2:

I must commend you for this service you offer. I have learned a lot this morning in reading your questions and answers while trying to locate answers for my two questions. I didn't realize that I had so many unanswered questions until I read everybody else's questions. I did see a lot of people ask about leg pain but felt that it wasn't the same thing as I have questioned you about.

Thank you in advance for taking the time for all of us with so many questions!

-Laura

Dear Laura: Your daughter's fear of men is certainly extreme and therefore raises the question of whether some traumatic event underlies the fear. The question of abuse, sexual or otherwise has to be raised and should not be dismissed unless you can be certain that there is no way that there could have been an opportunity. I noticed that you mentioned that she adores her male cousins, uncles, and grandfathers. There's a glaring omission from that list. What is her relationship with her father? What is YOUR relationship with her father? If there is a problem there, it could have a major impact on her relationship with men. (If Dad was left out as an oversight I apologize for inferring a potential significance to his absence from the list of men your daughter adores.)

Your daughter's willingness to talk to strange men may, in fact, not indicate anything about her relationship with men, but rather, may simply indicate an intelligent thought process on the subject. If she approaches a man rather than the man approaching her, and the man is not in a uniform, she assumes he's not going to do anything to her. Her familiarity with male relatives automatically makes them safe. But men who do things to her (which she associates with uniforms perhaps) are threatening to her.

Now, to be fair, her reactions don't have to imply any psychopathology. Men are inherently more frightening to children than women. Their voices boom and they are bigger and seem rougher to children than women. And most children still have a lot of contact with women but not as much contact with men. If many of your daughter's contacts with men, other than family members, have been unpleasant, such as doctor visits, her reaction is logical with a child's logic. Unfortunately, her battling with doctors, dentists, etc., only serve to reinforce her impression since the battles are themselves an unpleasant experience regardless of whether or not any painful procedures need to be done.

If you cannot afford counseling or feel it is not warranted, I think you do have to try to deal with the behavioral aspects of this yourself. Regardless of how frightened she is by the experience at the doctors office, she has to know that you are allowing him to do what he is doing and therefore she must behave. When I see a difficult child I am very patient and do my best to soothe and calm the child. After all, I'm a pediatrician and my patient is a child. Children sometimes act out and get frightened, and once they get going they don't respond to reason. But if all efforts fail at calming the child, I expect full parental support in controlling the child. That starts before the visit with the mother preparing the child for what will happen and telling the child what kind of behavior she expects. It continues during the visit not only with the parent helping to hold the child but also verbally reinforcing that the doctor is doing what has to be done with Mom's (or Dad's) approval, and that the child is NOT permitted to kick or fight. And it ends with discussion after the visit about anything that happened. The discussion can allow the child to express her feelings and fears but must include reinforcement of what behavior parents expect and what behavior parents don't permit. Appropriate punishments must be meted out as reinforcement. The bottom line is that kicking the doctor is unacceptable behavior. We can understand why a child misbehaves, but understanding does not excuse the misbehavior. If we don't teach a child to behave differently just because we understand, the child will not learn. The doctor is not harming your daughter, even if he has to do something that hurts, and your daughter has to learn the difference because there are times when it IS appropriate for her to protect herself and lash out. You must teach her the difference. For all we know, this problem began with a well meaning adult telling her to never let any man touch her.

Sincerely,
Dr. Warren

-Laura

Thank you for your time.

-TL

Dear TL: Roseola is thought to be caused by a Herpes virus known as HHV-6. The mode of spread of HHV-6 is not yet known, but the frequent detection of the virus in saliva of healthy humans suggests spread from healthy adults. Transmission is now believed to be via contact of salivary secretions from adults shedding HHV-6.

Since most adults are already immune to HHV-6 your exposure to the child who had Roseola would play no significant role in your ability to spread the disease. The incubation period is about 5 - 15 days making 4 days a little short. Since there are many causes of fever, it is just as likely that your daughter's fever is unrelated to Roseola. The peak age for Roseola is 6 - 12 months. By age 2 most children are already immune to Roseola from HHV-6 infection without symptoms or from having had Roseola.

Sincerely,
Dr. Warren

-Kathy

Dear Kathy: Sweating helps to bring a fever down. When a fever breaks it may very well be accompanied by sweating; however, since fevers may go up and down during an illness, there may be multiple episodes of sweats when the fever goes down and chills when the temperature goes back up before the illness ends.

The chills your daughter had were part of the way her fever went up. The blankets made her more comfortable when she had the chills, but because she fell asleep with the blankets on, she had those extra wraps holding the heat in even after the chills were past. Once the fever started to come down, the blankets impeded her temperature drop causing her to sweat profusely. The best thing to do when a child is chilled with a fever is to give him a blanket for comfort but then remove the extra wraps and have the child dressed lightly as soon as the chill is past.

For more information, read my article about Fever.

Sincerely,
Dr. Warren

Thank you!

-JT

Dear JT: Milk is not harmful, even in large amounts, except for those children who don't tolerate milk. Milk is also not constipating. The problem is that toddlers who drink too much milk fill up on the milk and then don't get enough fiber in their diets so that they become constipated. The milk is nutritious, but it would be wise to cut down on the milk and encourage your baby to eat more food instead.

Sincerely,
Dr. Warren

-JS

Dear JS: The chicken pox vaccine has been in use in the US since 1994; however, basically the same vaccine had been in use in Japan since 1974. Since none of the kids who received the vaccine in 1974 are senior citizens yet, we don't have living proof of the vaccines efficacy in later life. We do know that the vaccine is a live virus which provokes immunity in much the same way that real chicken pox does, so that it should provide lifelong immunity to most people. Our experience with the vaccine shows that those children who do get chicken pox after being vaccinated generally have a milder case. Aside from the fact that we expect the vaccine to provide lifetime immunity to chicken pox, if we do a good job of immunizing children against chicken pox, 50 years from now there won't be any children incubating chicken pox to expose susceptible senior citizens.

Successful vaccination programs can sometimes eliminate the disease. That's what happened with small pox. We're on the verge of seeing the same success with polio. You've misunderstood the concern about the polio vaccine. We have NOT found out that the vaccine is no good. Remember that even though there is no 100% safe vaccine, you can't compare the risks of the vaccine to the risks of doing nothing without including the deaths and complications of preventable diseases as a risk of not vaccinating. Immunizations save lives. The current concern about the polio vaccine is that a very small percentage of children who get the live vaccine get paralytic polio from it. We've known that for a long time, but when there was a lot of polio around, the risk of getting paralytic polio was higher without the vaccine. Now that the vaccine has wiped out polio, taking that risk is no longer justified, especially since we have an effective killed vaccine that doesn't carry the risk of causing polio. As effective as the killed vaccine is, I doubt that it could have wiped out polio like the live vaccine did. The risks of the live vaccine were known. This knowledge is not new, and the risks have not increased. They were acceptable for a time. But now that the vaccine has done its job, it's time to put it away and not see any more cases of vaccine related polio.

Sincerely,
Dr. Warren

I was just wondering if you knew what this was. Is it caused by a food allergy or environmental allergy or just a diaper rash. allergies run in the family. The other day she was playing under the apple trees in the grass.

Anyway, thank you for your time. Any advice would be useful.

Thanks,
-Kelly

Dear Kelly: Most children who wet their beds do it in their sleep. At 3 years of age, many children still wet their beds. As they get older it stops. If she is still wetting by the age of 5 or 6, then it is time to consider treatment. For more information, read my article, Bed Wetting.

Since the rash occurred after your daughter wet herself it is very likely from wetting herself. It's essentially diaper rash and should respond to a diaper cream like Desitin, A&D, Balmex, Triple Paste, etc. If she wets every night or most nights, you should consider having her wear a diaper or Pull Up to bed.

Sincerely,
Dr. Warren

-Carlos

Dear Carlos: I doubt the condition on your lips is related to the bumps on your penis. Essentially, you're talking about skin findings, basically a rash, and in spite of the best description, the only way an accurate diagnosis of a rash can be made is for it to be seen. Since it's persisted for a year and it bothers you, it's time to show it to a doctor.

Sincerely,
Dr. Warren

My son came out with the cordon round his neck, he had 3 round of it around his neck, the doctors cut his cordon as soon as they can and they left the room with him. He didn't cry at the first moment and we(me and my wife) didn't heard he cry for 5 minutes more or less, the doctor explaned us that the time wasn't too much to be worried, but I'm still worried because:

1. I don't know if he could receive air through the cordon, because the doctor had to cut it as soon as he could.
2. How can I note if he suffer consecuencies, how can I realize of it, he has now five months.

-EZ

Dear EZ: If the umbilical cord is wrapped around a baby's neck and tightens, it will obstruct blood flow through the cord as well as constrict the airway, therefore, getting the cord off the neck as quickly as possible is of utmost importance. After an infant is born, even though the umbilical cord is still attached, it can no longer be depended on to provide oxygen to the infant and must be cut in order to start the newborn's life. The umbilical cord is always cut immediately after birth. It is not left until the newborn cries. It would not improve the baby's chances of survival or prevent brain damage.

Your infant was apparently removed from the delivery room for resuscitation. Even if he didn't cry, if his heart was beating well and oxygen was being delivered to his lungs through resuscitation with a bag and mask or through a tube, then his brain should not have been deprived of oxygen. Only the doctors who cared for him can tell you how well or not well the resuscitation went. He apparently recovered.

If your baby is doing what normal 5 month old infants do and has good muscle tone and interacts with you as a 5 month old should then you can be sure he didn't suffer any serious consequences from his birth. None of us can know at 5 months how brilliant and accomplished our children will grow to be. Only time will tell if your child has any subtle neurological or intellectual deficits, and even if he does you may not know if it is related to his birth.

Sincerely,
Dr. Warren

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