13 June 2005
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physican who knows you and cares about you.
Dr. Warren
-AF
Dear AF: Rashes are tough to diagnose without seeing them, but it sounds like your daughter has impetigo, which is a superficial skin infection with staph or strep. You might be successful at treating it with an antibacterial soap and Bacitracin ointment, but generally I treat impetigo with Bactroban, which requires a prescription. If the rash is still spreading or the sores are not healing, see your doctor.
Sincerely,
Dr. Warren
Thanks!
-ACM
Dear ACM: If your son has been on a milk based formula like Enfamil or Similac, he should have no difficulty switching from formula to whole milk. Introduce one bottle of milk in place of formula. A few days later, introduce another. Continue changing his bottles from formula to milk in that fashion until all the bottles are milk. Remember, give whole milk, not skim or low fat, until the baby is 2 years old.
Sincerely,
Dr. Warren
She is from a broken home and lives with her mother, my daughter. The mother father relationship is terrible. She has stayed with my wife and me while her mother works since she was three months old. At 18 months she was about potty trained when her father moved out. Since then she has refused to relieve herself in a normal manner. We have four adult children which includes her mother which we potty trained. We know how to do it, but we are baffled by her behavior.
The child is very close to my wife and me, and from the child's comments, I believe that she is trying to force her mother and father to live together. Most of her play and play acting centers around "family," mother, father and children.
Any ideas?
-JC
Dear JC: Your love can help your granddaughter get past the psychological traumas associated with her broken home, but it can't make them go away. She may indeed be harder to toilet train because of emotional reasons. No matter what the causes of your granddaughters recalcitrance with regard to potty training, you can only deal with what you can change or control. Even if you had experience potty training a dozen kids, one child who refuses to potty train can be an enormous challenge. It has nothing to do with your skills. Ordinary measures don't work. The only advice I can give is to bring your granddaughter to the toilet quite regularly and praise even the slightest correct behavior, even if it doesn't result in using the toilet. Read my articles, Potty Training and Fecal Soiling for more details on encouraging appropriate toilet behavior. At some point, you may have to bite the bullet and get rid of the pullups. Your granddaughter may be seeking comfort in the warmth of soiling and infantile behavior which goes back to a time when her parents were together.
Sincerely,
Dr. Warren
Thank you.
-CA
Dear CA: The swollen gland behind the ear may be the result of inflammation in the ear canal from the ant. The vomiting and diarrhea is probably a separate illness. If your granddaughter had an infection of the ear canal significant enough to make her ill, she should have a red, swollen, tender ear. Allergic reactions with flu like symptoms can occur with serum sickness, but that is a fairly extreme allergic reaction and is associated with hives. To the best of my knowledge, ants are not known to carry any diseases which affect humans.
Sincerely,
Dr. Warren
-MR
Dear MR: I am not familiar with Panquil; however, I generally do not recommend any sedatives for infants. Unfortunately, anything that can sedate an infant can also result in a period of time when the child becomes stimulated and out of control. Think about how wild some kids become when they're over tired. Sedatives can sometimes eliminate normal inhibitions before they result in sleep. As another example, think of how some people behave under the influence of alcohol.
People who use sleep aids successfully use them because they want to go to sleep, and so they don't fight the effects of it. You certainly wouldn't want to keep your baby heavily sedated for the whole flight, which means you'll have to deal with her sleep/wake cycles. Under the influence of drugs, things could be worse.
By the way, a 10 month old should not be waking 2 to 3 times a night, but that's another issue. You may find that the flight is actually easier than home since she will be right with you the whole time. Her sleep/wake pattern may not be as much of a problem as keeping her entertained during her normal daytime period.
Sincerely,
Dr. Warren
-RS
Dear RS: I am not at all familiar with such foods as ready brek or weetabix. I don't know if they're unique to the UK, but we don't have them here in the USA. We generally don't advise starting any foods before 4 to 6 months, at which time we offer cereal and fruit. Check my article Feeding Your Infant for a full discussion.
Sincerely,
Dr. Warren
-EH
Dear EH: Unfortunately, a collapsed ear drum is not a medical diagnosis even though it may serve as an explanation to a patient regarding the doctor's findings. I would be guessing that your ear drums appeared sucked in against the little bones. That could result in popping and a sense of pressure in the ears, and since the ear drum cannot vibrate freely when it is sucked in, hearing will be somewhat decreased. That is not a serious or emergent condition, but the need for care depends on what symptoms you're having and how persistent the symptoms are. You didn't tell me why you went to the ER. You should be aware that ER visits are more costly than office visits and rarely provide the best care except for serious or emergent conditions.
By the way, the subject line of your e-mail was "holes in both ears." Were you told that your eardrums were ruptured, or did you just assume that's what the doctor meant? You didn't mention it in your question. A persistent ruptured drum may eventually require surgical repair, but in itself would not make you feel ill. Getting water into the middle ear through a ruptured drum could cause pain and even result in an infection.
Loss of balance can be associated with middle ear and inner ear inflammation but should not be associated with simple congestion of the ears. Ear conditions do not cause migraines, but anything which makes you not feel well can aggravate or provoke a migraine if you're prone to them.
Sincerely,
Dr. Warren
-[unsigned]
Dear New Jersey: Middle ear infections can sometimes result in a ruptured drum which will cause drainage of blood and pus. This is frightening but not serious. The point at which the drum ruptures is usually very painful, followed by relief of pain. If the drainage is continuing, your daughter may have a ruptured drum. Treatment with ear drops and appropriate follow up are necessary, so contact your doctor.
If your daughter was scratching at her ear because of the ear infection, she could have some bleeding from a scrape in the canal. If your daughter can reach it with her finger, you should be able to see it with a flashlight. If you can't see a scrape or scratch, a doctor visit is in order for continued bleeding.
Sincerely,
Dr. Warren
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