24 October 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
-DG
Dear DG: I have no experience with regard to your question. In searching the recent medical literature on cerebral palsy and dislocated hips the only articles I found discussed surgical treatment. If you have read both pros and cons the answer regarding weight bearing for cp children with dislocated hips must be controversial. If you wish to share the pros and cons you've read about with me, I may be able to comment on them.
It stands to reason that not all children with cp and dislocated hips are the same. The status of their contractures, hip joints, duration of dislocation, and potential for surgical intervention may differ. Therefore, the best thing to do would probably be to get the recommendation from the treating orthopedist.
You've enumerated some of the potential advantages of weight bearing in your letter. The medical maxim for treatment would be that the benefits of treatment should outweigh the risks. That means that the statistical likelihood of benefit should be greater than the likelihood of risk, the benefit itself should be worth taking the risk for, and that the risks should not be so serious that even if the frequency of complications was rare, the complication would be unacceptable. These principles apply even to something as simple as prescribing antibiotics. There's no question that antibiotics have saved lives, but if a person may die from an antibiotic reaction or is faced with a resistant infection due to supergerms created by overuse of antibiotics, it's easy to see how the risk/benefit ratio must be assessed before instituting treatment. Even very safe treatments usually carry some risk which may be unwarranted compared to vague or uncertain benefits.
Sincerely,
Dr. Warren
Thanks alot
-CD (medical intern)
Dear CD: Oral rehydration solutions, when properly mixed, can help prevent dehydration and avoid a hospitalization and IV fluids. When not properly mixed and administered they may result in hypernatremia or hyponatremia.
If a child is vomiting, even if the child is already dehydrated, the fluid must be given in small, progressively increasing amounts, frequently. If the child consumes enough to fill his stomach and then vomits the child gets sicker instead of better.
The amount of rehydration fluid to be given should be calculated based on the child's weight but should not generally exceed 1 quart per day with additional other fluids given to satisfy the child's thirst. Excess electrolyte fluids may result in hypernatremia whereas too much solute free fluids may result in hyponatremia.
If the child is able to eat, he may get some of his salts from food. As the child progresses toward a normal diet, his need for electrolyte rehydration fluids decreases.
Sincerely,
Dr. Warren
Any comments you have on my situation , or falls in infants in general , would be appreciated.
Thank you for your time.
-AWS
Dear AWS: There is no rule that all infants hitting their heads from a fall should have a CT scan. A child who is asymptomatic and has not lost consciousness requires only observation. The fact that your son's normal sleep pattern was disturbed after the head injury is very likely a result of the head injury; however the fact that his sleep pattern has returned to normal and that he has been otherwise normal in every respect since the injury makes it unlikely that any significant head injury resulted. At this point, no further action is needed unless the baby should become irritable, lethargic, or start vomiting.. Late consequences in a child who had no significant head injury symptoms are unlikely.
Sincerely,
Dr. Warren
-TL
Dear TL: Unfortunately, many lice are now resistant to many available lice treatments. There are prescription treatments containing either lindane or malathion which may work under such circumstances. Therefore, you should call your pediatrician.
Sincerely,
Dr. Warren
-KM
Dear KM: Eye color is controlled by more than one gene, but in general, brown eyes is a dominant trait. That means that someone who has brown eyes may be carrying genes for other colors. The likelihood of having green eyes depends on the gene combination the offspring receives from his brown eyed parents. While I can't quote you any percentages, it's certainly possible.
Sincerely,
Dr. Warren
Over the past month Alex had an EEG and a MRI. The EEG was normal, however the MRI came back abnormal. The images showed that Alex's brain had not fully formed and that there was an area between his left frontal lobe and cranium. After many questions, the formal diagnosis was cerebral atrophy. Now the question becomes, what can we expect from this? The neurologist was very "closed-mouthed" on what my son's future holds. "Let's just wait and see and have follow up check-ups."
In a follow up with our regular pediatrician, she told us that despite what the MRI showed, she really did not see hardly anything abnormal in his behavior. ("He looks like a normal healthy six month old.") He has good hand-to-eye coordination, he is rolling over on his own, he is attempting to sit by himself, he tracks people visually and audibly and best of all, he is putting some weight on his legs when in his exercer-saucer.
At this point, we still seeking more information on what this could bring for the little guy in the future. I have looked everywhere on the internet for information on "cerebral atrophy" to no avail. We know that he certainly could have complications, but we just do not know what or to what degree. I know that each case would be different, but we'd like to know what the range of possibilities could be.
Do you know of any way to find additional information on this? Is it called something else? Are there support groups for this ailment? Can his brain rewire to compensate for any of the lack of brain development?
As always, I appreciate any information you may have.
-KN
Dear KN: The problem you are running into is that cerebral atrophy is not a diagnosis, but a finding on MRI. Cerebral atrophy may be seen with cerebral palsy. The problem in predicting your son's outcome is that the degree of cerebral atrophy makes a big difference in the types of problems the patient may have. If there is no progressive neurological condition, your child's brain may indeed compensate (rewire). The range of symptoms with cerebral atrophy can range from profound mental retardation and severe cerebral palsy to subtle learning disabilities. It all depends on what parts of the cerebrum are atrophied, how extensive the atrophy is, and when and how the brain injury leading to atrophy occurred.
Sincerely,
Dr. Warren
-KL
Dear KL: Meconium is the stool that fills a fetus' intestines. Healthy babies do not pass meconium until after birth. Fetal distress anytime during the pregnancy or labor could cause the fetus to pass meconium. If there is meconium in the amniotic fluid, it can get in the babies mouth and be breathed in when the newborn takes its first breath. That is meconium aspiration. This can result in respiratory problems, pneumonia, and pneumothorax. It is an event at delivery which does not have any specific long-term consequences. The degree to which a baby is affected by meconium aspiration in later life depends on how sick the newborn was with the meconium aspiration and what complications resulted, if any.
Sincerely,
Dr. Warren
Thanks for any info you might be able to provide!
-Ms. K
Dear Ms. K: The skin of the scalp is more highly vascularized (has more blood vessels) than many other parts of the body. Indeed, lacerations of the scalp do bleed more than comparable lacerations on other parts of the body.
Sincerely,
Dr. Warren
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