21 November 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
-CH
Dear CH: If your son has had a complete evaluation by an orthopedist which revealed nothing and your son still cannot walk, then he should be evaluated by a neurologist.
Sincerely,
Dr. Warren
I read somewhere about children who experience even a mild form of trauma can have problems like this. Could the fact that she had Kawasaki Disease and when through such a horrible time at the hospital be a form of this? I remember the day we went to the hospital we were met in her room with at least 7 nurses / doctors. Mackenzie went through test after test... from about 5 pm to 10:30pm. And then more the next day. She was so upset and throwing up.
And then there is also the fact that she has a new baby sister. What can I do as a parent to help her become more independent? Is this a normal faze for a toddler?
Thanks for you advice.
-JB
Dear JB: Your daughter's early experiences in the hospital because of he Kawasaki Disease may certainly play a role in her separation problems. It is equally possible that her basic nature made her hospital experience that much more traumatic. We all have differing innate personalities which make some people more easy going than others and some people more intense. Our relationship with the world and other people is very much affected by our response to them and their response to us and the patterns we learn as a result.
Children who have separation problems need to experience small separations successfully to learn that they'll be okay and that Mom comes back. The problem is to keep the separations brief enough so as not to be excessively traumatic and aggravate the child's separation anxiety, and yet to make the separations long enough for it to be a real separation experience. The child's chance for success is increased if the separations become a routine. In other words, a child can get used to an hour separation every day after lunch (for example) more easily than a daily separation for an hour at random or unpredictable times.
Start with brief separations where you announce where you will be and how long it will take. Show your daughter a clock or an egg timer so that she can see when to expect you back. Give her a specific activity to do in your absence. Announce your return and emphasize that "Mommy always comes back!" Praise your daughter for any shred of success at handling your absence. Be specific: "I'm proud that you didn't cry." "Thank you for staying here like a big girl!"
Sibling rivalry contributes significantly to separation problems. Sibling rivalry doesn't stem from negative feelings about the sibling, but rather from anxiety about the loss of status or attention from mother. Any negative feelings develop from that. The problem for mother is that ANY attention given to the new baby is perceived as having been taken away from the older sibling. There is no foolproof way to avoid that. The best advice I can give is to:
Sincerely,
Dr. Warren
Do you have an idea of what that could be? Should I worry?
Thank you.
-F
Dear F: There are many possibilities to explain your symptoms. You could be hypoglycemic (low blood sugar) which could be related to what you eat and when you eat it. You could be working in an overheated environment or doing repetitive work from which you need a break. I would need to know more about your daily routine to have an idea what is causing your problem. Even with that information, I could not give you a definitive answer without examining you and running some tests. The persistence of these symptoms requires further evaluation. Make and appointment with your doctor for a physical.
Sincerely,
Dr. Warren
-Worried
Dear Worried: Unfortunately, this is a situation in which the doctor's simplified explanation does not provide me enough information to know what he actually found. I don't know of any condition referred to as an "extended" intestine. If the baby's intestine is distended (that means swollen or overly full - perhaps that's the word your doctor used) the doctor will be watching to make sure the baby is passing stool normally. If the baby is not, the doctor would be concerned about a congenital condition called Hirschsprung disease in which a segment of intestine lacks nerves so that the intestine does not move stool normally past that point. It is diagnosed by rectal biopsy and treated with surgery.
Your best bet is to ask your doctor what the significance of his findings are and what he is concerned about. If he is unsure, you should ask for a referral to a pediatric gastroenterologist.
Sincerely,
Dr. Warren
-LJ
Dear LJ: According to Sabiston: Textbook of Surgery, 15th ed., Copyright © 1997 W. B. Saunders Company
The rectus abdominis muscles are held close together near the anterior midline by the linea alba. The linea alba itself has an elongated triangular shape and is based at the xiphoid process [tip] of the sternum. The linea alba narrows considerably below the umbilicus so that the medial [toward the center] edge of one rectus muscle may actually overlap the other. The most common variant of normal anatomy seen in the abdominal wall is diastasis recti. This consists of an upper midline protrusion of the abdominal wall between the right and left rectus abdominis muscles. This abnormality represents a weakness of the linea alba and does not require treatment unless an epigastric hernia occurs in association with the diastasis recti. Frequently, patients or their families need to be counseled about the innocuous nature of the abnormality.Behrman: Nelson Textbook of Pediatrics, 15th ed., Copyright © 1996 W. B. Saunders Company in a discussion of the Physical Examination of the Newborn Infant says,
The abdominal wall is normally weak (especially in premature infants), and diastasis recti and umbilical hernias are common, particularly among black infants.
Sincerely,
Dr. Warren
-MT
Dear MT: The belief that grinding of the teeth is caused by parasites is very popular. Tooth grinding is actually common in healthy children. It may be increased by stress. If you have any concern that your daughter may have parasites, she should have a stool specimen tested for parasites. It is never a good idea to just give medicine. If the medicine isn't needed you risk side effects without getting any benefit. Overuse of these medicines may make the parasites resistant to them.
Sincerely,
Dr. Warren
-JNB
Dear JNB: Menstrual cycles are not always regular and periods may on occasion come early. If your girlfriend had one early period or has occasional early periods, there is no cause for concern. If your girlfriend is having bleeding between periods, prolonged periods, or pain, she needs to see her gynecologist.
Sincerely,
Dr. Warren
-Dianne
Dear Dianne: Your son's friend could have a type of fungus infection called a kerion celsi. If he has been treated with antibiotics for secondary infection and creams, the infection will fester since it requires treatment with a systemic antifungal such as griseofulvin. The boy could also have some other unusual skin condition which I could not guess at without seeing him. He should see a dermatologist.
Sincerely,
Dr. Warren
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