27 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
Thank you for your time and help!
-L
Dear L: In order to provide complete care to patients a pediatrician has to take care of his sick patients in the hospital. In addition, pediatricians need to see their newborns in the hospital. If you work in a private office, in order to participate in most insurance plans, you will need to have hospital privileges for those patients that need to be admitted. Fortunately, most of pediatrics involves very little hospital work. If you don't want to do any, you could get a job working in a clinic. In order to be a pediatrician, you will have to complete a residency which involves a lot of hospital work. You may find, after you've had experience, that the small amount of hospital work required in pediatrics is okay for you.
If you see a lot of patients, sooner or later you're bound to see a child with leukemia or cancer. Their care will be handled by a specialist, but it will be up to you to make the initial diagnosis, or suspect it and send the child to the specialist. After the child's cancer care begins, you will not want to abandon your patient. The patient and family still depend on you for support and care unrelated to the cancer.
Sincerely,
Dr. Warren
Thank you.
-NF
Dear NF: Teething may cause some changes in bowel habits, but severe, watery diarrhea is not caused by teething. For more information on diarrhea, check my article, Management of Gastroenteritis.
Sincerely,
Dr. Warren
Thanks.
-CC
Dear CC: If the limp just started, repeat x-rays in a week or so, or a bone scan may show an injury or inflammation which is not now evident. It also depends what they x-rayed. Sometimes a problem in the hip may appear to be in the leg. If there are no orthopedic problems, a neurological evaluation may be in order.
Sincerely,
Dr. Warren
-Kathy
Dear Kathy: The only thing significant that causes shaking and twitching is seizures. It is not likely that a child would have seizures just as he drifts off to sleep and at no other time. Some children do startle a little just as they drift off to sleep. If it is more than brief, an evaluation may be in order, but it is most likely movement associated with a semi-sleep state.
Sincerely,
Dr. Warren
Dear Readers: These days, with so many parents having video cameras, I would recommend that if you see something weird that you think the doctor will need to see, try to tape it and show him what you're concerned about.Sincerely,
Dr. Warren
-[unsigned]
Dear Possibly Pregnant: X-rays aimed at the chest result in very little radiation of the pelvic area and probably pose no risk to a fetus; however, as a precaution, any woman of child bearing age should have her pelvic area shielded for a chest x-ray. Although it is unlikely that your x-ray caused any problem, the concern is that x-rays can damage genetic material in dividing cells and so could conceivably result in birth defects, especially early in pregnancy.
Sincerely,
Dr. Warren
-CT
Dear CT: Teething could contribute to sleeping problems, but if it's not keeping your baby awake at night, it shouldn't keep him awake during the day. Twelve hours of continuous sleep is more than most parents get from their 5 month old. Since he gets a good night's sleep, even though he's tired enough to be cranky, he may not be tired enough to fall asleep, especially if he senses activity around him. If you feel he needs the sleep, or you need the time during the day to get things done, you may have no choice but to leave him in the crib at nap time whether he sleeps or not. If you stick with a routine he may fall asleep at nap time. If he doesn't sleep, there's nothing you can do to make him sleep.
Sincerely,
Dr. Warren
-Angie
Dear Angie: Recurrent pneumonia in a child with reactive airway disease is not so unusual as to suggest an immune deficit, but may be a good enough reason to consult a pediatric pulmonologist. Since your daughter has had numerous episodes of blue lips, a heart evaluation by a pediatric cardiologist might help. Sometimes heart disease can lead to recurrent pneumonia. Reflux may also be a cause of wheezing and recurrent pneumonia. Fluoroscopy and an upper GI series may not be sufficient to rule out reflux. A consultation with a pediatric gastroenterologist for a pH probe may be necessary if there is a significant suspicion.
Vomiting and diarrhea is a common enough childhood illness and therefore would not be a reason to suspect an immune deficit. If your doctor finds the frequency of your daughter's infections to be unusual or your daughter has unusual infections, then a consultation with an immunologist would be in order.
Sincerely,
Dr. Warren
-YD
Dear YD: Since the Rh positive blood type is a dominant trait, a person can be Rh positive with just one gene for positive. If two such people have a child and neither contributes their positive gene to their offspring, the child can be Rh negative. Therefore, the simple answer is, yes, your son could be the father of the O negative baby.
Sincerely,
Dr. Warren
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