7 February 2005

1. Urinating in Strange Places
2. Poor Growth
3. Nail Injury - Nail Fell Off
4. Thrush All Around
5. Pityriasis Rosea
6. Sleep Problem
7. 3 Symptoms
8. Swimmer's Ear
9. Disclaimer

• Read Questions & Answers in Another Column

Urinating in Strange Places

-Lost in CA

Dear Lost in CA: It's impossible for an adult to think like a 4 year old, and therefore, sometimes very difficult to understand some of their odd behaviors. Your child obviously does not have difficulty holding his urine since he is not wetting himself, but rather, is intentionally urinating in odd places. While he may not have realized he'd wet his face, it doesn't sound like an accident in light of the other incidents. I'd look for some unusual stresses in his life and perhaps consider seeing a child psychologist. I would be more concerned about the possibility of a urinary tract problem if any of these incident occurred outside the house. Just to be sure, it may be wise for your son to have a urinalysis.

Sincerely,
Dr. Warren

Do you think there is matter to be worried and performe endocrine or genetetic tests? I am afraid if we wait further, it will be too late to correct her growth curve.

Thank you in advance.

-FB

Dear FB: The 5th to 10th percentile is within the normal range. If your child's growth has been steady along that percentile rather than falling down to that percentile, there is no reason to consider endocrine or genetic testing. Her size at 21 months is not really predictive of her final height since some family growth patterns include children who are small until after their adolescent growth spurt. Reviewing your family history with regard to childhood growth may help you decide if your daughter's petite size is unusual. The most important thing you should do is review your daughter's growth chart with her pediatrician to see if there is any indication of poor growth.

Sincerely,
Dr. Warren

What should I have done? What can I expect for healing i.e. will the nail grow back and will it be deformed?

-AM

Dear AM: It is not unusual for the nail to be disrupted by an injury to the nail root. The new nail will most likely grow back entirely normal although there may be some distortion of the nail when it first starts to grow back. Your handling of this mishap was perfectly fine.

Sincerely,
Dr. Warren

Thanks for your site and all your advice!

-DH

Dear DH: An entire family with thrush would be an unusual situation, but is not dangerous. The one dose Diflucan treatment is used to treat vaginal yeast infections, but to the best of my knowledge, a 2 week course of Diflucan is recommended for treatment of thrush. Your daughter can also be treated with Diflucan. It would probably be best for all of you to be treated with Diflucan at the same time. If there should be additional recurrences after that, you need to find out why. If one of you is the source of the infection, that person needs to be checked for diabetes and immunity problems.

Sincerely,
Dr. Warren

Thank you.

-RV

Dear RV: Pityriasis Rosea is a rash caused by a virus. It does not cause birth defects. It does not appear to spread from person to person. With the exception of the rash, which may itch, it does not generally cause any symptoms. I see about 5 cases a year, so it is not rare, but neither is it common like colds or other infections.

The rash starts with a large oval scaly patch followed 2 weeks later by an outbreak of small oval scaly patches on the trunk. They may go up the neck and even behind the ears, but they do not extend onto the face. The rash can last up to 6 weeks. There is no treatment; however, hydrocortisone cream and antihistamines may be useful for itching.

Sincerely,
Dr. Warren

This is a question about how to teach him to go to sleep at night without crying.

Since birth, we have been walking him around the house right before bedtime to make him fall asleep.

He is now sleeping in his crib in his own room, but needs to be walked around to fall asleep.

We decided it was time to put him in his crib at a set time (10pm) and let him cry himself to sleep.

We were going to be strong and let him cry for as long as he wants (we would go in after 5 minutes and comfort him for 2 to 3 minutes, then go in after 10 minutes, 15, etc.)

We have done it for 3 days in a row now with no apparent improvement.

The poor little guy cries his heart out like you wouldn't believe, for about one hour.

After so much crying at the top of his lungs he becomes exhausted and eventually falls asleep flat on his face.

We now have a dilemma: how long do we keep this up for?

We read that most babies will respond to this technique within 2 to 4 days.

We are willing to try it for about 2 more days (for a total of 5 days), but then what?

Do we give up?

Do we keep on torturing him?

We feel so incredibly cruel by doing this to the sweet little fellow...

P.S. By the way, he almost never cries throughout the day so long as you're with him and paying attention to him.

Maybe we have a special baby that just can't take being alone at all?

Please help!

-Concerned Parents

Dear Concerned Parents: I don't know where you read that a child could learn to put himself to sleep in 2 to 4 days. If that were true, I wouldn't get desperate letters about childhood sleep problems. I do believe that it's a good idea for infants to learn to put themselves to sleep in their own cribs. I'd recommend reading my article Helping Your Child to Sleep Through the Night.

If your baby is already sleeping in his own crib and sleeping through the night, you have to decide when you feel it's necessary to take the next step. If you view what you are doing as torture, you cannot do it. If your aim is to wean the baby from being rocked to sleep in your arms, why not start by putting him in his crib and soothing him in the crib until he falls asleep. If necessary get him a bit drowsy in your arms first. Then gradually eliminate that part. Once going to sleep in the crib is established start decreasing the amount of time you soothe him, leaving him to put himself to sleep more and more awake as time goes by.

Sincerely,
Dr. Warren

1. She has a swollen gland in her neck (front of neck - under jaw bone).
2. She has had diarrhea at least 3 times a week for months. (not continous, but only one episode, 3 times a week, with no weight loss).
3. She has a HUGE level of thirst.

Thank you for your time.

-Lisa

Dear Lisa: No particular illness comes immediately to my mind which would include this combination of symptoms. Viral infections may cause swollen glands, and diarrhea. Acute diarrhea may cause thirst because of fluid loss. Your daughter's diarrhea symptoms have been intermittent over too long a period of time to be an acute viral infection. Those symptoms are more consistent with lactose intolerance, parasites such as giardia, or irritable bowel disease.

Sincerely,
Dr. Warren

-E

Dear E: Swimmer's ear is an inflammation of the ear canal. It is unrelated to middle ear infections. Those who are prone to swimmer's ear can use well fitting ear plugs to prevent swimmer's ear. A mixture of vinegar and water put into the ear canal after swimming or a drop called Swim Ear available at your pharmacy can be used to prevent swimmer's ear.

Sincerely,
Dr. Warren

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