4 April 2005

1. Late Period
2. Hand, Foot, and Mouth Disease
3. Thumb Sucking
4. Red Mark
5. Recircumcise?
6. Cystic Hygroma
7. Pyramidal Insufficiency
8. Sleep Problem
9. Disclaimer

• Read Questions & Answers in Another Column

Late Period

-JK

Dear JK: The menstrual cycle does not do any adjustments related to frequency of sex. Menstrual cycles can be irregular and delayed for a variety of reasons including stress. Worrying about pregnancy may be such a stress. Take the stress out of the relationship and protect both yourselves against disease by using a condom every time. It only takes one unprotected intercourse to end up with unwanted consequences for which you could pay for the rest of your lives or with your lives.

Depending on the type of test used, some pregnancy tests are not sensitive enough to detect pregnancy after 4 days. If your girlfriend has not had her period yet, she should repeat the test and/or see her doctor.

Sincerely,
Dr. Warren

Several people have mentioned the possibility of it being something called "Hoof and Mouth". What exactly is that, and do you believe my son could possible have it. He cannot eat anything except pudding and jello, he does drink enough to keep him from getting dehydrated. If it is 'Hoof and Mouth', what, if anything, can be done about it.

My doctor said if the warts did not begin to look better in a few days, that I should take him to a dermatologist and might possibly have to have them burned off with nitrogen.

Does this sound possible? What help can you offer? Any advice would be greatly appreciated.

-LL

Dear LL: You're describing hand, foot, and mouth disease, which is caused by coxsackie virus. A lot of people refer to it as "Hoof and Mouth Disease" because they're familiar with the name of that cattle disease and not the name of the human affliction. The two diseases are unrelated.

As I stated, hand, foot, and mouth disease is caused by coxsackie virus. It is a summer virus which is common in children but uncommon in adults. Sometimes it just causes a sore throat with canker sores and other times causes the rash on the hands and feet. Since I didn't see your son's hands and feet, I cannot state with certainty that the spots are not warts. But since I suspect that your son has hand, foot, and mouth disease, I doubt very much that they are warts.

As with most viruses, there is no treatment except to provide symptomatic relief with ibuprofen or acetaminophen (Tylenol), and to encourage fluids. Ice pops often feel good on a sore throat. The illness runs its course in about 5 days. The spots on the hands and feet will disappear just as the mouth sores will.

Sincerely,
Dr. Warren

-Grandfather W

Dear Grandfather W: Thumb sucking is one of those childhood problems whose approach depends on what your main concerns are. If your daughter-in-law has major concerns about future dental problems associated with thumb sucking, then her value judgment is that it worth the stress it may cause her child to put an end to it. Sooner or later he ought to stop, and there's simply no rule that says when the best time is. Your grandson could be just as stressed if his mother waits until he's 6 to make an issue of it. I've seen too many older children sucking their thumbs to promise that he'll simply outgrow it. A big part of childhood involves moving on to the next stage of maturity with its demands and expectations. Since each child has a unique personality, it's up to the parents to look at the big picture and decide how (and when) it's best to handle it. Sure that thumb provides your grandson comfort, but that same thumb could be a source of grief in grade school if other kids start talking about him sucking it.

I haven't given you a definitive answer because there is none. It depends on how your grandson's teeth are doing, and how well he handles the demands made on him. I'm not inclined to think thumb sucking is such a big deal that it's worth making a kid miserable over, but that doesn't mean parents shouldn't try to get kids to stop. In any event, if you've felt in the past that you shouldn't meddle, I congratulate you on your wise decision, and would advise that this is not an important enough issue for you to change your approach on. If your grandson has an attentive and loving mother, he will certainly survive her efforts to keep his thumb out of his mouth.

Sincerely,
Dr. Warren

Thank you.

-SD

Dear SD: A red mark which has persisted more than six weeks is not a bruise. It could be a vascular mark (like a birth mark) or a rash. Without seeing it, I cannot tell. If your doctor doesn't know what it is, he should refer you to a dermatologist.

Neither one red mark nor sweating at night would be a reason to think of leukemia.

Sincerely,
Dr. Warren

The doctor said it is just a fat pad that makes his penis look like it hasn't been done. I have done what he advised, but just recently it has gotten red again. I am concerned that I will need re-circumsize him. My son is not a "fat baby", but he is what I call "healthy". He weighs about 23-25 lbs., and turns one soon. If this has to be done should he be put to sleep because of the pain? What are some of my options? Thank you for your patience.

-R

Dear R: Foreskins cannot grow back. If the head of your son's penis can be easily exposed by pushing the skin back, then the circumcision was satisfactory. It is not unusual for the pubic fat pad to push the skin from the shaft of the penis up over the penis so that the buried penis appears uncircumcised. If you are patient, as he grows, the fat pad will diminish and the appearance of his circumcision will improve.

Considering that there are very few medical benefits of circumcision, I would almost never recommend recircumcising an infant and can't think of a circumstance where it would be necessary. The reason you are thinking about it is for appearance only, and although I haven't seen your baby's circumcision, since your pediatrician tells you, just as I have, that the circumcision is okay and the pubic fat pad is responsible for the appearance, I would not risk surgery.

Sincerely,
Dr. Warren

Thank You

-TG

Dear TG: I found surprisingly little information about Cystic Hygromas. According to Sabiston: Textbook of Surgery, 15th ed. a cystic hygroma is a neck mass made of lymphatic vessels in children. Cystic hygromas develop from the jugular lymph sac when it fails to communicate with the thoracic duct or internal jugular vein and generally become evident in the first 2 years of life. In some instances, the mass is detected by prenatal ultrasonography. More commonly, however, the mass is either noted at birth or becomes evident when sudden enlargement the hygroma occurs during an upper respiratory infection and causes difficulty breathing because of severe tracheal compression. Removal is the therapy of choice; however, this is not always possible, as the mass may be more solid in nature and infiltrate structures such as the tongue or pharynx. The cystic form is frequently intimately adherent to vital structures (e.g., vagus nerve, phrenic nerve) that should not be sacrificed, since this lesion is benign. Sclerosing agents, steroid injection, and irradiation have been used but have not been effective.

According to Scott: Danforth's Obstetrics & Gynecology, 7th ed. in a table of the "Risk of a Chromosomal Abnormality With Selected Sonographic Findings" the risk of a chromosomal abnormality with a cystic hygroma was greater than 60%. This does not imply that it is an inherited disorder, which, to the best of my knowledge, it is not. Chromosomal abnormalities can occur during or after fertilization or develop during formation of the egg or sperm. I did not find any indication that cystic hygroma was associated with any other abnormalities or that it was seen as part of any other genetic disorders or malformation syndromes.

Sincerely,
Dr. Warren

• Perinatal encephalopathy of mixed genesis.
• Bilateral pyramidal insufficiency syndrome in the late stages of recovery
• Umbilical hernia

Can you help me.

Thanks.

-J & B

Dear J & B: I haven't heard any reference to the pyramidal system since medical school when I learned about the neurological effects of syphilis. According to Kaplan: Comprehensive Textbook of Psychiatry, 6th ed., Copyright © 1995 Williams & Wilkins

Historically, motor systems have been divided into pyramidal (corticospinal) and extrapyramidal (basal ganglia) components; that division is based on clinical findings suggesting that lesions of each system result in distinct motor syndromes. For example, lesions of the extrapyramidal system result in involuntary movements, changes in muscle tone, and slowness of movement; lesions of the pyramidal system lead to spasticity and paralysis. Because of those findings, the pyramidal and extrapyramidal systems were thought to independently control voluntary and involuntary movement, respectively. However, that division is no longer accurate for several reasons. First, other structures of the brain outside the traditional pyramidal and extrapyramidal systems, such as the cerebellum, are involved in the control of movement. Second, the pyramidal and extrapyramidal systems are not independent, but the neural circuits of those systems are interconnected. Finally, although the basal ganglia are important in the control of movement, the system also appears to be involved in other functions of the brain.

Sincerely,
Dr. Warren

Sincerely,
Lynn

Dear Lynn: It's amazing what kinds of things kids will do when they get upset. The problem is, even if it was purely accidental, your daughter may have found the perfect weapon to get her way. If you let her have what she wants because she is banging her head, she will learn to use it to get her way.

You didn't tell me what you used to do that you're trying to eliminate (feed her to get back to sleep, take her into your bed), but let me reemphasize that you cannot make a child fall asleep. You can only teach her what she can expect when she cries during the night. If your goal is for her to stay in her bed (which is a reasonable first goal) , you need to deal with this without taking her out of the bed except when necessary to care for her. If you must put up padding to protect her to have peace of mind, do it. If you must go in to soothe her, or keep putting her back down, keep doing it consistently. Unlike the "cry it out method" going in to intervene will take longer, but will make it more palatable for all of you. But you have to progressively decrease the amount of intervention to make any progress. And don't be afraid to use the word "No." At 27 months, she may not be cooperative, but she's old enough to understand that you're telling her "no head banging." She's also old enough for you to talk to her about sleep during the day when she's not upset about it. Talk to her about it every day to prepare her for what will happen at night.

Sincerely,
Dr. Warren

If your questions haven't been answered here, perhaps you would like to

ask Dr. Warren a question?!?