30 January 2006

1. Reactive Airway Disease Overdiagnosed?
2. Sleep Problem
3. Mouth Sores and Fever
4. Help Me Figure it Out
5. Milk for an Infant with Multiple Allergies
6. Newborn Screening
7. Will Rash Scar?
8. Tongue Out
9. Disclaimer

• Read Questions & Answers in Another Column

Reactive Airway Disease Overdiagnosed?

-Bobbie

Dear Bobbie: If you lived in my area, I could probably guess who your doctor is since there is a practice around here where all the kids seem to have reactive airway disease. On the other hand, if your son has been using a nebulizer for 7 months, by now you must have some sense when he needs it and if it helps. If the treatment helps your son, there would be no reason to question the diagnosis. Given the fact that asthma can be familial, two children in a family with reactive airway disease does not suggest the doctor is hung up on the diagnosis.

There are some seasonal viruses which can cause wheezing. If your daughter does not have recurrent symptoms, this may be a one time thing.

As regards insurance, many states prohibit insurance companies from excluding preexisting conditions. In any event, if you have been continuously insured, when you change insurance there is usually not an exclusion for preexisting conditions.

Sincerely,
Dr. Warren

-SB

Dear SB: Based on the persistence of your son's sleep difficulty since infancy and the fact that sleeping with you did not help, I'm inclined to think something is bothering him during his sleep. Without a thorough evaluation, I cannot tell you what. Study with video, EEG, and vital signs monitoring in a sleep/wake disorders center may help make a diagnosis, but before you get to such a complex evaluation, I would consult a gastroenterologist about possible gastroesophageal reflux. Some children with reflux have their worst symptoms when they are lying down. Antacids like Tums may provide brief relief, but if the esophagus is inflamed from chronic reflux, there are much more effective treatments.

Even if a cause is found and treated, your son will have to establish good sleeping habits. Please read my article, Helping Your Child to Sleep Through the Night.

Sincerely,
Dr. Warren

My mother took the baby to her pediatrician - and he diagnosed her with gum desease due to someone around her must have touch her while they had somekind of mouth infection. A week later, she still won't eat, and my mom noticed small white warts on the baby's palet. The doctor prescribed Chlorespectic. I tried it on the baby - but it doesn't seem to help.

Please respond.

Thank you.

-RB

Dear RB: Swollen gums, fever, and mouth sores in an infant are generally caused by herpes virus. Usually the infant catches it from someone who has an outbreak of fever blisters. The illness is self limited, however, it takes considerable effort to get adequate fluids into babies with this illness. If their fluid intake is not sufficient they can become dehydrated. Sometimes ices or ice pops are an excellent source of fluids for children with painful mouths because the coldness of the ices helps numb the mouth.

You should ask your doctor to tell you the actual diagnosis and explain the course of the illness to you so that you know what to expect and when you should be concerned.

Sincerely,
Dr. Warren

• Blood pressure 117/74
• Hemotolagy sed rate 30
• hemogram platelets count 572
• white blood count 18.7
• somtimes has raynaud's (hands turn white)
• fever 103 (may be because teething)
• Thrush had since birth
• appiatite down - lost lb with in 5 days
• tired, irratable, seems to breath heavy at times
• sinus trouble since birth
• urine is strong at times
• bowels are soft to extremly loose stools
• gassy stomach since birth
• had colic 4 months long gave Mylicon and colic tablets and infant tylenol for discomfert on lactos free milk.

  motrin for fever and discomfort. Pediacare cold for sinuses.

• had lab tests 11-30-xx, has not responded,

-T

Dear T: The brevity of your question - a bunch of details without a narrative - leaves me with very little sense of what your baby's problem is, and especially how long it is going on. A high sedimentation rate, high platelet count, and fever could all be seen with an acute infectious illness, on which could be over by the time you get my response. On the other hand, if the fever has been prolonged and is still persisting, there are many possibilities. Please look at several of the letters on my site about prolonged fever. Certainly, with Raynaud's phenomenon, one has to consider the possibility of a connective tissue disorder like lupus. On the other hand, if your baby simply has cool white hands during the fever, that may just be vasoconstriction to conserve body heat which is part of the body's fever response.

Sinus trouble since birth?!? That's a pretty tough conclusion to draw accurately in a young infant. Thrush and colic - fairly common infant afflictions. On the other hand, if the thrush doesn't respond at all to treatment, maybe your infant is sick because of an immune deficiency syndrome.

WBC 18.7 with fever. If it's an acute onset, it calls for thorough evaluation to look for bacterial infections such as pneumonia or urine infections (assuming no cause is found on examination).

BP 117/74 is high for a 7 month old. If it persists when the baby is not ill, it should be further evaluated.

Sincerely,
Dr. Warren

-MC

Dear MC: An infant who is allergic to multiple proteins would either need human milk or a hypoallergenic formula such as Alimentum or Nutramigen.

Sincerely,
Dr. Warren

Thanks

-MB

Dear MB: I'm going to guess that the comment actually says "metabolic inborn error screening: ok." That means the baby was tested for inborn errors of metabolism and everything was fine. In the United States newborns are screened for inborn errors of metabolism by sending a blood sample to the state laboratory. In NY state (I don't know the other states) the test looks for hemoglobin abnormalities like Sickle disease, hypothyroidism, and rare metabolic diseases like phenylketonuia. Phenylketonuria was the first screening test done on newborns when the program was instituted and many people still refer to the test as the PKU. Others refer to it as the Newborn Screening. No matter what you call it or where it was done, the fact that the test was okay is another piece of good news for you about the baby you're adopting.

Sincerely,
Dr. Warren

At age 14 months, my son developed a spot on his left cheek, by 18 months, this had increased to three on his left cheek and 1 on his right cheek. He is now 38months old and still has them. They vary in intensity and swelling at irregular times. Below the skin are lumps which about twice a year can flame up dramatically and on occasion will burst releasing some yellow puss. The spots are not generally sore unless touched. He does not scratch or interfere with them.

To date he has received several courses of topical treatments including steroid creams, antibiotics and antifungal creams. He has taken courses of general antibiotics none of which has helped in the slightest. A swab of the pus was passed to the doctors but has not shown any unusual bugs "apparently". He is about to go onto a series of more specific antibiotics and Oral and topical Vitamin A creams although the alternative that was also mentioned was a biopsy taken under a general anaesthetic. An option we unsurprisingly are not keen on. The current diagnosis is A-typical infant acne. The doctor we use is very good but we feel the diagnosis is a stab in the dark as he has run out of alternatives.

Question

Best regards

-C & B

Background info

PS an excellent site, one of the best medical sites I've seen, keep up the good work.

Dear C & B: I appreciate your sending photographs; however, even a photograph is not as good as seeing something in the flesh. From the photo, I cannot distinguish the spots from any other kind of pimple. I do see a suggestion that your son has an eczematous rash on his chin, possibly a contact dermatitis from moisture. Again, it's hard to be sure from a photograph, but I mention it in case it has any bearing on your son's diagnosis.

Regardless of whether or not your pediatrician is correct in his diagnosis, you have a legitimate concern regarding the potential for future scarring. Whether a consultation yields a different diagnosis or a different treatment plan, I think it's time to see a dermatologist. A biopsy may be necessary, but given that the lesions are external, it should be possible to do that with sedation and local anesthesia rather than general anesthesia.

Sincerely,
Dr. Warren

Thank you.

-Katie

Dear Katie: Sometimes children do weird things that adults don't understand. If they like it, they keep doing it. You are not describing a typical behavior for a 7½ month old, but if there are no other health issues, abnormalities on physical exam, growth problems, or developmental problems, this one behavior does not signify anything.

Sincerely,
Dr. Warren

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