2 May 2005

1. Pediatrician vs. Family Practitioner
2. Ear Wax
3. Tossing an Infant
4. Getting Rid of the Bottle
5. Immunity to Cold Viruses
6. Recurrent Pinworms
7. Blood Type Causing Problem?
8. Dr.'s Credentials for Very Sick Kid
9. Disclaimer

• Read Questions & Answers in Another Column

Pediatrician vs. Family Practitioner

Thanks.

-N & J

Dear N & J: Because family practitioners spend portions of their training becoming well versed in multiple specialties, they are not as expert at pediatrics as pediatricians, but they are well qualified to provide routine pediatric care and to deal with most usual childhood illnesses. Lets not forget that many of the common problems we see doctors for are similar in children and adults, and those family practitioners who have experience with children know how the treatment of children differs. In addition, a family practitioner who is caring for the whole family has the added benefit of familiarity with family factors affecting the child. In those situations where a child's condition may require the expertise of a pediatrician, the family practitioner can consult with and refer the child to a pediatrician just as the pediatrician consults and refers to other specialists when needed.

Beyond training, expertise is a matter of experience. If you live in an area where there is a shortage of pediatricians, then the family practitioners will have lots of experience treating kids. You should have no qualms about having your child cared for by a family practitioner.

Sincerely,
Dr. Warren

-PP

Dear PP: You should not assume that your son always has a large buildup of wax in his ears just because an ear cleaning once produced a surprising amount of wax. One of the most common causes of excess wax buildup is ear cleaning with swabs (Q-tips). No matter how much wax comes out on the swab, because of the shape and size of the ear canal, some wax will be pushed further into the ear. Over a period of time, this can result of a significant buildup of hard wax in the ear.

Those children who have dry wax may benefit from having mineral oil placed in the ear regularly. I have even found mineral oil to be effective for softening other wax. Hydrogen peroxide or a commercial preparation such as Debrox can be used to melt ear wax. None of these things should be placed into a painful or draining ear.

Unless your child has a chronic ear wax problem, it is probably not necessary for you to do anything. In general, the fewer things you do to the body, the better. You should check with your son's doctor to see if he advises any regular ear cleaning routine for your son.

Sincerely,
Dr. Warren

-CB

Dear CB: There could be some legitimacy to your concern if the manner in which the infant was tossed in the air caused the head to jerk back and forth abruptly; however, if the baby enjoys this manner of play, it's likely that she is not being hurt by it and has learned to control movement of her head and neck during such play. A gentle toss in the air that a child anticipates should be fine.

Sincerely,
Dr. Warren

How can we help to both, specially the 2 year for leave the bottle. Did we made the rightMy baby has 2 year and 4 months. He refuses to leave the bottle even he can drink in the trainer glasses. He drinks juice in his kindergarden but refuses to do in the home. Today my husband and I decided to dissapear the bottles. We have one more baby of 1 year and we think that it would be good to start with him too to leave the bottle. How can we help to both, specially the 2 year for leave the bottle. Did we made the rigth being so drastically -dissapear the bottles-? Is ggod age for the baby of 1 year to leave the bottle? Heeeeeelp!!!! being so drastically -dissapear the bottles-? Is good age for the baby of 1 year to leave the bottle?

Heeeeeelp!!!!

-DM

Dear DM: It's perfectly fine to just take away all the bottles from a 2 year old, but it may be easier and less drastic to cut down on them first. If your son is very attached to his bottles, make sure you do not allow him to walk around with them. Decrease his attachment by letting him have it only at the table. Then decrease the number of times you give it to him each day and ultimately stop giving it to him.

Most people don't get rid of bottles by 1 year of age. While it may make it easier for you to get your 2 year old off the bottle, you have to consider your 1 year old separately. It won't hurt him to come off the bottle. You have to decide if he's proficient at using a cup and whether or not he's really ready.

Sincerely,
Dr. Warren

Also, how long can cold germs live on one's hands and on surfaces such as door knobs, counter tops, etc.?

Thanks for your wonderful web site!

-TE

Dear TE: According to the Red Book Report of the Committee on Infectious Diseases of the American Academy of Pediatrics, by adulthood antibodies to many types of cold viruses have developed; however, these antibodies are type specific and provide little protection against other types of cold viruses, of which there are well over 100, not counting other upper respiratory viruses like influenza and RSV. I did not find any information about how long cold viruses remained viable on surfaces, but transmission is primarily hand to hand from the infected person, followed by self inoculation by touching the eyes, nose, or mouth. I'm sure cold viruses remain viable on hands and surfaces for at least a few hours which is more than enough to keep the germs spreading.

Sincerely,
Dr. Warren

Thanks so much. I've sure enjoyed reading your answers to readers' questions.

-NC Mom

Dear NC Mom: There's no question that some patients have a recurrent problem with annoying, embarrassing things like pinworms or lice while others never get it. It's partially the luck of the draw, but it's also what you're exposed to. Pinworms are not carried by any other animal and so must be transmitted by another human. Their eggs can lie dormant in the environment for 2 to 3 weeks and still be infectious. People can reinfect themselves by scratching their itchy bottoms and then getting the eggs back into their food or directly into their mouths. The best control measures involve careful hand washing including scrubbing the nails with a brush, and treating all family members at the same time regardless of whether or not all are symptomatic.

Sincerely,
Dr. Warren

I have a general question about kids. I heard that a couple ( the wife has O type blood, husband has A type blood), either they don't have kids, or they have kids having blood related disease( like leukocythemia). Is that true? I get this information from China. And there are some number showing that in some hospitals in Shanghai, China.I don't work in this area,I am an engineer, so I don't know much about this and who to ask.I hope you can help me. If you are not the right person to ask, could you do me a favor and tell me who to ask? I really appreciate.

Looking forward your reply.

Thank you!

Have a nice day!

-M

Dear M: If a woman has O blood type and a man has A blood type, they could have a healthy child with type A or type O blood. The baby will not have a blood disease from this genetic combination; however, if the baby is type A, the mother could produce antibodies to the baby's blood causing the baby to become jaundiced and anemic. This is rarely serious and can be dealt with in the newborn period. It does not cause any lifelong problem.

Sincerely,
Dr. Warren

He has undergone the 2nd surgery and is scheduled for his 3rd. We have a totally new set of Dr.'s, (X City is a teaching Univ) and need to check them out and find out some options. Unfortunately, during the 2nd surgery, there were some things thrown at my sister right before surgery that had not been discussed with them prior - like transplant and that just threw them for a major loop. It was not discussed with them by Dr. D as an option at all. The surgery team hit her with it unexpectedly because of the poor success rates with Norwood.

Question #1

Question #2

We know a few stats, there have been approximately 5 children born since my nephew with this problem at X.C. and none have beaten the odds. So, we totally understand, if we need to travel to see a physican in this speciality, it is not an issue. We need to know who has dealt with this, hopefully on a successful basis.

Wish I could be of more help, but there aren't many leads out there for us to chase.

I look forward to your response! The little guy is quite the bundle of personality, running all around and too precious to lose!

(Bet you don't get many request for Norwood Procedures! Be thankful!)

Thank-you.

-A Very Loving Aunt

Dear Very Loving Aunt: I don't know any way to find out about a doctor's credentials besides asking. Even if you're in a teaching hospital there must be one person in charge of the cardiac surgery department and the doctor who did the initial surgery must be somewhere on the planet. Start by speaking to your baby's cardiologist (not the surgeon) and ask him what he knows about the surgeons. Ask him if there is a cardiac hospital or other major teaching hospital where you can get another opinion. Then have a conference with the chief of the cardiac surgery department and your surgeons. Ask them how many of these procedures they've done and their success rate. Ask them where they would recommend going for a second opinion. Ask why transplantation was not discussed initially (It may not have been a consideration at the time when a palliative procedure was needed to keep the baby alive. Now you're talking about long term management). Ask for a comparison of their success with transplantation vs. corrective surgery. Ask how their statistics compare to other major teaching hospitals. You're entitled to this information and you're entitled to be direct in your questioning.

Sincerely,
Dr. Warren

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

ask Dr. Warren a question?!?