11 July 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
I recently discussed this problem with her pediatrician, who recommended giving her mineral oil both in the morning and before bed and to use Haleys MO if she didn't have a bowel movement for over two days. He also advised having her sit on the toilet regularly after meals.
The problem is the following. Lately, my daughter has been trying to go to the bathroom numerous times throughout the day with little success. She has also been leaking mineral oil, especially lately as we have increased the amount we are giving her. For example, yesterday she had a large bowel movement but only after leaking mineral oil throughout the day. Today, she again leaked mineral oil repeatedly and although she felt the urge to go and repeatedly sat on the toilet, she was unable to move her bowels. She is beginning preschool next week and I am not sure how to handle this problem. I feel she has reached a point where she wants to overcome her problem but we are now unable to get back to a regular schedule of bowel movements. Is it possible that her bowel is distended due to repeated withholding and that she no longer gets the urge to go as often? If there is anything you can suggest that might help us or any further insights we would be very grateful. We have tried all types of incentives such as stickers and rewards but the issue is no longer that she doesn't want to go to the bathroom it is that she doesn't seem able to even when she has the urge to go.
Her diet is fairly high in fiber. She eats a lot of fruit, some vegetables, and whole grain bread and pasta. She doesn't, however, drink that much.
I have read your article on fecal soiling. She hasn't reached the point of fecal soiling, and I would like to help her before she does.
Best Regards.
-Heidi
Dear Heidi: Children who chronically withhold stool do get a dilated rectum resulting in a decreased urge and decreased sensation. This will improve if the child has a bowel movement regularly. If your daughter is still having difficulty having regular movements, do NOT decrease the mineral oil even if there is leakage. If the stool is soft, she should not be having difficulty having a bowel movement, but in spite of her desire to go in the toilet, she may still be tightening up and holding it in as she tries to push it out. She will need to become comfortable having bowel movements on the toilet before that stops. When she sits on the bowl she should be encouraged to stay there until she has the BM. If you sense that she is anxious (and perhaps even if you don't) you should talk to her to relax her. Just keep calmly telling her you know she can do it and that it won't hurt.
Sincerely,
Dr. Warren
Note to Readers: For more information on this subject read my article Fecal Soiling
Otherwise my baby seems fine. I am kind of concerned about her.
Dr. Warren, can you please throw some light on this topic?
Your expert advice will be greatly appreciated.
-EP
Dear EP: Antibiotics do not affect growth or development and are just as safe for young infants as for older children. Children do not become resistant to antibiotics, but bacteria do, so it is in everyone's best interest to avoid overuse of antibiotics; however, if there is a good reason to treat a child with an antibiotic, the risk of the untreated infection outweighs the concern about resistant organisms. Appropriate use of antibiotics is not considered overuse. I don't know anyone who would recommend not treating a UTI or ear infection in a young infant.
The issue of appropriate treatment of UTIs is not the only reason to be rigorous about the procedure for diagnosing a UTI. A UTI can only be diagnosed by culture of a sterile specimen, either midstream, bladder catheterization, or suprapubic aspirate. Bagged urines tend to be unreliable, but if the culture is negative it is a true negative. Positive cultures from bagged urines should be confirmed by a more accurate method. Bagged urines which are not collected with sterile technique are useless for culture. Young infants who have UTIs require a thorough evaluation of their urinary tracts and follow up cultures. Any unexplained fever in such an infant would require a culture (preferably catheterized). Therefore, the diagnosis of UTI should not be taken lightly.
Sincerely,
Dr. Warren
-SF
Dear SF: There's a good reason that the instructions on my web site tell people not to expect a quick response and discourage people from asking emergency type questions. You wanted to know if you should watch something overnight or seek immediate care and you're not getting my answer until 2 days later.
Headache, nausea, and fever are common symptoms with a variety of virus infections which will just run their course. Treatment with Tylenol or ibuprofen (Motrin, Advil) is all that is necessary to relieve symptoms. Unfortunately, these same symptoms can be seen with meningitis, therefore, if a child with these symptoms seems very ill or doesn't improve with medication, he needs to see a doctor fairly quickly.
Sincerely,
Dr. Warren
Thank you!
-F
Dear F: Some babies cry more than others and harder than others. Very few 3 day olds have any kind of regular sleep pattern. If your pediatrician says everything is okay, I think you need to give your baby a little time to settle into the world and give your self a little time to get used to caring for him before you look to make any changes.
Sincerely,
Dr. Warren
Her doctor believes she might have a heart murmur. (which her aunt - my sister has). My father has had a quad by-pass and his father a triple by-pass.
Any information you could send to me would be most helpful.
Thank you.
-Mrs. K
Dear Mrs. K: Cholesterol and saturated fats in food work together to cause elevated cholesterol in the blood. Cholesterol and saturated fats are found primarily in animal fat. Polyunsaturated oils from plants such as corn and safflower, and monounsaturated oils such as olive oil can actually help lower cholesterol when included in the diet in moderation. To lower cholesterol it is best to avoid pre-prepared foods except those made specifically for low cholesterol diets. When you prepare your own foods you control the ingredients. Follow these rules in choosing and preparing your foods.
Plain cereals like corn or wheat flakes, rice crispies, or Cheerios are just fine served with skim milk. Fancier cereals, especially granola, is higher in fat. Read the labels.
Candies made primarily of sugar like sucking candies won't affect cholesterol, although they're not great for the teeth in excess. Candy bars and chocolates are higher in fat and should be limited. Check labels to see if the saturated fat and cholesterol is listed.
Chips made with vegetable oil are okay. Pretzels are low in fat. Read labels on crackers to see what's okay. Air popped popcorn is fine. Check labels on microwave popcorn.
Ice cream is high in fat and cholesterol. Ice milk is a better alternative. Ices have no fat. There are some excellent low fat, no cholesterol ice creams on the market today.
Most fast foods should be considered avoidable except for special occasions. The special sauces that make them popular often add tons of fat. Pizza is okay on occasion since mozzarella cheese is naturally lower in fat, but it's by no means fat free.
If I've missed any major foods, write back to me and let me know so that I can provide you the information and revise my list.
Sincerely,
Dr. Warren
Dear Readers: I should have taken the opportunity to point out that, especially with a family history of heart disease, while it is desirable to get a child's cholesterol under 170, it is more important to make sure a growing child is adequately nourished. My loyal fans know that I would never advocate giving a child junk food just to get him to eat, but if a young child's diet is limited, I wouldn't eliminate the higher fat meat he eats if I couldn't successfully introduce a satisfactory alternative.
-BD
Dear BD: It is possible that your new husband comes from a family that wasn't very demonstrative and is uncomfortable with affection between a parent and child. I can't tell you, from the information you've given me, if you may be holding or comforting your son too much, but if your husband objects to your holding him or giving him any affection at all, that is definitely a problem. All children should get hugs and affection and comfort. It's hard to imagine it being too much unless it's given under inappropriate circumstances (such as when a child is misbehaving or demanding your attention when you are busy, or interfering with your relationship with your husband) or unless you're holding onto your child in such a way as to stifle his independent exploration of the world.
Is your husband jealous? I don't know. But just as your child mustn't come between you and your husband, your husband mustn't come between you and your child. Love is big enough for everybody to get his share. You shouldn't have to ration your child's love to please your husband. And, as the man of the house, your husband will be your son's father. A father's love is also important for a child's well being. If you and your husband can't agree about how to deal with your son, and both be happy with your agreement, it could be a serious impediment to a successful marriage. If you don't reach an agreement after discussing this answer you should consider joint counseling.
Sincerely,
Dr. Warren
Our two year old is a very healthy and generally extremely happy little girl. She is very social and has good verbal skills. She has been walking since she was 10 months old. She has a good relationship with her 4 year old sister and seems like your normal, smiley kid. Most nights she goes to bed pretty happily. She shares a room with her sister and they go to bed at the same time. Our older daughter is a real sleeper and falls asleep pretty quickly. Every 2-3 weeks, the 2 year old) decides she doesn't want to go to sleep (though she is visibly tired) and after trying to wake her sister by calling her name, and calling for my husband and me, she makes herself cough until she throws up. We used to get very upset and cuddle and snuggle and make a big deal. Lately, we have gotten quite mad and told her to stop doing it. Tonight, I just went up, changed the crib, changed her, no hugs, no kisses, put her back in the clean crib and left - she went right to sleep. All of this occurs within 20 minutes of us putting her to bed.
We don't know if we are handling it right. Also, we are afraid that she not use throwing up as a control mechanism or a way of expressing anger fearing that it could become a mechanism when she is older. We are very sensitive as my husband's sister( who is 37 yrs old) is an anorexic and bulimic - our 2 year old has no way of knowing this.
What are your thoughts?
-Beth
Dear Beth: First, as a reassurance, there is no association between the vomiting some children do when they cry to the point of vomiting and eating disorders. While it is true that children can learn from experience to use vomiting when they get upset to get their way, these children are coming from an entirely different place than the food, weight, and binge issues associated with eating disorders.
There is nothing a parent can do to prevent a child from vomiting when he gets upset or screams. Some kids gag when they get upset and others don't. But if it gets a child his way when he vomits he can very quickly learn to threaten vomiting to see if it will get him his way. So what do I suggest? Well, it appears you're following Dr. Warren's usual advice before you've even read it. Keep a change of clothes and bed linens handy and any cleaning supplies you will need so that if vomit happens you can clean it up quickly and get baby back to bed with as little fuss as possible. Expect a mess and be prepared for it so that you don't get angry, since even that may provide too much attention, and the guilt you feel afterward can make you do things which add confusion to the message. Just be matter of fact. Clean the mess. Gently tell her she has to go to bed. Just as gently tell her you don't want her screaming and vomiting. Then leave.
Sincerely,
Dr. Warren
-Dustin
Dear Dustin: It's very common for adolescent boys to develop some swelling of their breasts when they are going through the body changes of puberty. This is called adolescent gynecomastia. The breast tissue swells in response to the hormones of puberty. As puberty progresses, your body becomes more and more like an adult male and most of the time the breast swelling goes away. Of course it's embarrassing, but lots of boys have it. They just don't talk about it because they're embarrassed. Most teenage boys are very self conscious, so it probably looks enormous to you even if other people wouldn't notice.
If the swelling doesn't go down or is really large, you should ask your parents to take you to a plastic surgeon to talk about making things better for you, but you shouldn't rush into a surgical treatment for something mother nature usually takes care of.
Sincerely,
Dr. Warren
Sincerely,
-Dustin
Dear Dustin: When boys develop gynecomastia, the swollen breast is usually sensitive. It usually feels like a lump behind the nipple since it generally doesn't enlarge enough to actually form a breast. Both sides may not be affected equally. Sometimes only one gets swollen. If it's very painful or you are concerned, have your parents bring you to the doctor.
I doubt that anyone will ask you about it. You're self conscious about it so you think everyone will notice it. How to answer if someone asks depends on how they ask and what your relationship with them is. If you think someone is concerned, tell him it's a normal part of growing up and it's okay. If you think someone is just curious, tell him it's swollen. Why say more than you have to. After all, you're a kid. You don't have to be able to explain it. If you think someone is giving you a hard time, just answer by asking him why he's looking at your chest. Finally, if you want, you can go swimming with a shirt on. That would probably be noticed, but then if someone asks, you can always tell a little white lie and say your doctor wants you to limit your exposure to the sun.
Sincerely,
Dr. Warren
Sincerely,
-Dustin
Dear Dustin: Gynecomastia is the word for swelling of the breasts that some boys get as a normal part of puberty. I apologize for assuming that you would remember that from the first answer I sent you. I've included those responses above this so that you can reread them and refer to them.
The darker colored area of skin immediately surrounding the nipple is the areola. A sub-areolar cyst, would be a cyst under the areola - in other words, a cyst below the nipple just where you feel the lump. Cysts form when glands in the breast become obstructed and fill with fluid. That would be most unusual in a teenage boy. It is not dangerous; however a cyst cannot be expected to go away on it's own and so would require surgery if it is big enough to cause a problem.
Neither I, nor the other doctor you questioned can know for sure what your lump is because we haven't examined it. In trying to give you advice and make a diagnosis by e-mail, I'm playing the odds. I've examined many teenage boys who were concerned about swelling of one or both breasts, and all of them had gynecomastia related to puberty.
I think you've gone as far as you can with this problem talking to doctors on the internet. Of course you're still welcome to contact me any time you like, but now that you've gotten several e-mail answers, if you're worried, it's time to show your parents what's worrying you and have them bring you to your doctor. It's admirable that you've tried to get some information on your own, but your parents should always know if there's something bothering you. It's up to them to make decisions about your health.
Sincerely,
Dr. Warren
-Dustin
Dear Dustin: When I was speaking about a cyst, I said it "would require surgery if it is big enough to cause a problem." I would define a problem as painful or bothering you. I would also include infection of the cyst as a reason to have surgery. Of course, I suspect you have breast swelling from puberty and not a cyst, and that would not require any intervention now. Your description does not sound very large.
I don't know for sure what your lump is and you are clearly worried about it. It's time to show it to your parents and let them decide if you need to see your doctor. Go away from your computer and show it to your parents now!
Sincerely,
Dr. Warren
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