29 August 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
Thanks a bunch.
Sincerely,
-Violetta
Dear Violetta: Please go to http://www.mindspring.com/~drwarren/student.htm where you will find your question and many others answered. If you consider that you would have to go to college for 4 years for almost any profession, adding on another 4 years for medical school is not a big deal. Right now while you're young, 8 years of school might sound like it's forever, but if you really want to be a pediatrician, by the time you finish your training, it won't seem so long. And don't forget, while you're in school you can still do important things with your life. My college years were among the best years of my life, and included time spent in community service working with kids. You live your life while you work for your goals. You don't wait to start living until you've accomplished your goals.
Sincerely,
Dr. Warren
Question #1: His penis seemed very small, about 1 cm. Only when he urinates it will erect to about 1.5 to 2 cm. Is this normal?
Question #2: How do we know if he has normal testicles? My husband felt there is nothing "hard" in my son's penis as those found in his own penis. Are there any differences between adult and children's testicles?
Thank you for your time in answering the above questions.
-M
Dear M: The average length for a 2 year old's penis is 4 cm; however this standard is for a stretched length with the ruler against the pubic bone measuring the part of the penis buried in the pubic fat pad. Unless you're doing a clinical stretched penile measurement (what parent does?) this number doesn't mean anything. If you're just looking at what you see extending above the pubic fat pad and not stretching it to measure it, your son's penis is probably a normal size.
An adult's testicles are much larger than an infant's, so you cannot compare. In addition, the testicles may be retractile, pulling out of the way when you try to feel them. At 2 years of age your son should be having, and should have had, many regular checkups. You shouldn't have to decide if your son's testicles are normal. His pediatrician should already know that. Ask him.
Sincerely,
Dr. Warren
-Kristi
Dear Kristi: Even though your question is "sweet and simple," the answer is not so simple. Even in the newborn period there is a large degree of variation with some healthy newborns sleeping as little as 12 hours per 24 hour day and others sleeping as much as 22 hours. An 8 year old should probably get 8 to 10 hours a day of sleep and a 4 year old 10 to 12 hours. Some younger children still take naps which must be taken into account, but most important is to recognize that sleep needs vary from person to person. My youngest always needed more sleep than her brother and sister.
If a child is never ready for bed at bedtime, does not appear tired, and wakes up early with plenty of energy, he probably needs a later bedtime. A child who always seems cranky and tired before bed or is too tired to function in the morning needs more sleep.
Sincerely,
Dr. Warren
-CH
Dear CH: Don't feed your infant every 15 minutes under any circumstance. If you must offer something, try water if it isn't anywhere near 2 hours. That way the baby will still be hungry enough to take a reasonable feeding at feeding time. If the baby doesn't take a full feeding, of course the baby will demand to eat sooner, resulting in this constant snacking behavior.
Spend every free minute you have for your baby enjoying her and bonding, but don't feel obliged to run to her every time she makes a noise and don't handle every cry with a feeding. When you are in the middle of something, don't stop what you're doing to run to the baby when she cries unless you believe it's urgent. You don't have to leave a baby crying to teach him patience. Infants are too young for that. But neither do you have to respond to every cry immediately. If you take the time you need for yourself and the chores you have, you will find the time you have with your baby more relaxed and fulfilling for both of you.
Sincerely,
Dr. Warren
Once again, thank-you for your time and thoughtfulness.
Your friends,
-J, C, & B
Dear J, C, & B: According to Behrman: Nelson Textbook of Pediatrics, 15th ed., Copyright © 1996 W. B. Saunders Company
When an unstable hip is recognized at birth, maintenance of the hip in the position of flexion and abduction ("human" position) for 1-2 mo is usually sufficient. This position maintains reduction of the femoral head and allows for tightening of the ligamentous structures as well as for stimulation of normal growth and development. Methods that can be used to maintain the hip in this position include Pavlik harness, Frejka splint, and a variety of abduction orthoses. Double and triple diapers, although controversial, are commonly used in infants with dislocatable hips because the latter devices usually do not fit satisfactorily. Treatment is continued until there is clinical stability of the hip and ultrasonographic or radiographic measurements are normal.The difference in success rates relates to whether the hip is dislocated or just unstable at the time of treatment. If the harness doesn't work, probably no other non-surgical approach will, but surgery is an option. A 95% success rate for a non-surgical treatment is pretty good odds, so think positive.From 1-6 months of age, a true dislocation may develop. As a consequence, treatment is directed toward reduction of the femoral head into the acetabulum. The Pavlik harness is the major mode of treatment in this age group. The harness attempts to place the hips in the human position by flexing them more than 90 degrees (preferably 100-110 degrees) and maintaining relatively full but gentle abduction (50-70 degrees). This redirects the femoral head toward the acetabulum. Usually, spontaneous relocation of the femoral head will occur within 3-4 wk. The Pavlik harness is approximately 95% successful in dysplastic or subluxated hips and 80% successful in true dislocations. If reduction is achieved, the harness is continued until radiographic parameters have returned to normal. If a spontaneous reduction does not occur, then a surgical closed reduction is indicated.
Sincerely,
Dr. Warren
Please respond.
-New Mother
Dear New Mother: Unfortunately, there is no way to guaranty that our lives can be happy and free of tragedy, and you're already acutely sensitized to the pain of SIDS because of your personal experience with it. What you need to do is put it in perspective. SIDS is fairly uncommon in the USA. Sleeping on the back decreases and infant's risk of SIDS, but sleeping prone is not a death sentence. Even before the increased risk of prone sleeping was recognized, when most infants were put to sleep on their bellies in the USA, the incidence of SIDS was still pretty low. In my 22 years as a pediatrician I've seen two. That's two too many, but the number is dwarfed by the thousands of healthy babies I've cared for. Once babies learn to turn over, we have to expect that they will spend some time sleeping prone. It's fine to put them back on their backs when we find them prone, but it's not reasonable to make a night's work out of keeping an infant on his back.
It's a mother's job to worry. That comes with the title. But if your worry is all consuming so that it interferes with your life and your sleep and defines your relationship with your baby, you should consider getting counseling. You may need help in dealing with what happened to your sister's baby. I would never suggest that any mother abandon vigilance in the care of her child, but over time, you will find that excessive worry will not serve you or your child well.
Sincerely,
Dr. Warren
Thanks.
-Katie
Dear Katie: Foods you eat should be digested and absorbed into your body within 2 to 3 hours. Medications and liquids taken on an empty stomach may be in your system within 20 minutes to an hour. Just think of how quickly you feel the effects of a pain medicine or glass of wine to get an idea of how quickly some things get into your body. Complex foods sit in the stomach for digestion for up to a few hours before they start their way through the intestinal tract.
Spicy foods may bother some infants. Cow's milk may also be a source of distress. You could try making a log of everything you've eaten in the previous 3 hours before a feeding any time your baby becomes miserable after a feeding. After you collect enough data, you might find a pattern. One caution: most infants have a fussy period between 6 PM and 10 PM every night. While the nursing mother may conclude it's what she ate for dinner that's causing the problem, formula fed babies experience the same thing.
For more information on your diet and nursing, contact you local chapter of LaLeche League or check the lactation consultant page at Parent's Place.
Changes in stool pattern or color can be seen when children are ill, but are also a normal part of life. The change you described really can't be used to guide you since it is within the range of normal.
Sincerely,
Dr. Warren
Thank-you!!!
-BM
Dear BM: After discontinuation of phototherapy it is not unusual for the bilirubin level to rebound and rise again. A level of 16 in an 8 day old is not a cause for concern; however, if the baby looks yellower or acts ill, or there are any specific risk factors such as blood type incompatibility between mother and newborn, then it will need to be monitored closely by the pediatrician.
Sincerely,
Dr. Warren
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