15 August 2003

1. Congenital Hip Dysplasia
2. Fused Labia?
3. Myeloproliferative Disorder
4. Nursing and Colic
5. Rash
6. Age Range of Pediatric Patients
7. Chest Pain
8. Mortality Rate Gender Differences
9. Disclaimer

• Read Questions & Answers in Another Column

Congenital Hip Dysplasia

Concerned,
Jerry

Dear Jerry: Hip dysplasia occurs when the hip socket (acetabulum) is shallow enough and the ligaments lax enough for the end of the thigh bone (femur), to slip out of the socket. It's important to make the diagnosis during infancy because it is easily treated by placing the infant in a brace which holds the thigh bone in the hip socket while the socket is developing. After a few months of growth the baby ends up with a normal hip joint. If the diagnosis is not made during infancy the hip joint may develop a false socket which will result in arthritis of the hip and could lead to permanent disability.

Double or triple diapering holds the legs out in the right position to keep the thigh bone in the hip socket. This is sufficient until the specialist determines if there is a need for treatment. If an infant is born with any problem, rest assured that at least this is one that can be completely cured with a safe and painless treatment.

Sincerely,
Dr. Warren

-AS

Dear AS: Labial adhesions (the labia or lips of the vagina sticking together and fusing) are fairly common in infancy. If the adhesions are thick and the opening is fused so as to cover the urethral opening and obstruct urine flow, then treatment is necessary. I have had success treating labial adhesions with Premarin cream; however, even after successful treatment, sometimes the labia may fuse again. I never use the Premarin for more than 2 weeks since it may be irritating. Repeat courses may help if followed by regular application of Vaseline between the labia, but multiple repeat courses are not desirable since Premarin is an estrogen and some of it will be absorbed.

In those children having recurrent adhesions, as long as their urine stream is not affected, the best thing to do is leave them alone. The adhesions will generally open under the influence of the hormones of puberty. For thick adhesions or real fusion of the labia with no opening, you would need to consult a pediatric urologist.

Sincerely,
Dr. Warren

Thanks for your help.

-JB

Dear JB: The term myeloproliferative disorder refers to a number of diseases whose common feature is an overabundance of abnormal cells in the bone marrow. Chronic Myelogenous Leukemia is the myeloproliferative disease which is probably the best known to nonmedical folks. Your exact diagnosis, if a myeloproliferative disorder is suspected, can be made by a bone marrow biopsy. Once you know the exact diagnosis you can better acquaint yourself with the symptoms, course, prognosis, and treatment options.

I am sure that "myloprolifedative" is just the way "myeloproliferative" looks in your doctor's handwriting.

Sincerely,
Dr. Warren

I thought that the colic and gases could be a result of something I eat so I tried to give him a formula, Similac, but I found out that he is allergic to milk - he developed rashes and showed a severe allergic reaction - , he also has got eczema on his face and legs. And started giving him solid recently.

My questions are?

• Since he is still suffering from colic, can that be from something I eat?
• Should I avoid drinking milk? even if I don't have problems in digesting it?
• Can the eczema be a result of something I eat?
• If I want to give him a formula should I try lactose free milk or soya milk?
• Should I try giving him a formula or it is better that I keep on breast feeding?
• Is there a way that I can find out the foods that my baby is allergic to?

Thanks a lot.

-S

Dear S: A colicky nursing infant may be reacting to something that Mom is eating. So can the eczema. When infants are allergic to milk as evidenced by developing eczema, they are generally reacting to cow's milk protein, not lactose. Lactose intolerance results from an inability to digest lactose and is not a form of allergy. If your baby is allergic to cow's milk, he could get gas pains from your drinking milk, even if you have no difficulty digesting it. Try eliminating all cow's milk products from your diet including yogurt and cottage cheese, and see if the baby does better.

Lactose free milk would not help if the baby is allergic to milk protein. Soy milk may be okay, but soy protein can also cause allergies. For a variety of reasons, human milk is the best food to offer infants. Avoidance of allergy is an important one. A 5 month old who has had eczema and colic would do best being fed human milk only. For additional information you might check the lactation information at the Parents' Place Web site or contact your local chapter of La Leche League.

Sincerely,
Dr. Warren

Sincerely,
-AK

Dear AK:

Sincerely,
Dr. Warren

-LS

Dear LS: Most pediatricians see "children" until their late teens or early twenties. Adolescent medicine is part of pediatrics. Most adolescents, no matter how big they are, have special needs which are best met by someone who generally deals with adolescents rather than adults; however, there is some overlap. Family practitioners see all ages, and some internists are comfortable dealing with adolescents.

In my office, not only do we see patients into their early twenties, but many ask if they can keep coming to us rather than having to find another doctor. Some pediatricians set aside hours just for adolescents. Your son might feel more comfortable with a family practitioner just because there are adults there as well. Or, if you live in an area with a teaching hospital, they may have a clinic for adolescents only.

Sincerely,
Dr. Warren

I am concerned that this may be caused by something else (not her heart) but I have no idea what else could cause such symptoms. Do you have any suggestions?

-AG

Dear AG: A heart rate of 130 is not likely to cause pain, and may even be elevated because of the pain. If several cardiologists have assured you that her pain is not cardiac in origin, then it is most likely musculoskeletal. An evaluation by an orthopedist may clarify that possibility. Other possibilities to consider for these pains could include gastrointestinal problems such as gastroesophageal reflux or hiatus hernia. Generally these patients are aware of having heartburn as well as pain. Another possibility to consider would be chiropractic evaluation and management.

Sincerely,
Dr. Warren

One more thing, please. Is it true that female babies are more resistant to diseases than male babies at birth?

Thank so much for your time, it is priviledge to be able to communicate with a man of such high scientific caliber as you. I hope to read from you soon.

Best regards.

-Cyril

Dear Cyril: At any age males have a higher mortality rate than females. You can check some details and actual statistics at the following sites.

• Infant Mortality Rates ... by Sex for Selected Countries
• Table HEALTH6 Child mortality rates by age, gender, race, and Hispanic origin, 1980-97
• Table HEALTH7.A Mortality rates among adolescents ages 15 to 19 by gender, race, and cause of death, selected years 1980-96

Sincerely,
Dr. Warren

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