13 March 2006
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
-ES
Dear ES: Head banging is a common habits in infants and toddlers. It usually appear in the latter half of the first year, particularly when the infant is moving from one developmental stage to another, for example, from crawling to walking. Although those habits usually disappear by the second birthday, it may persist for a longer period in about 5 percent of cases. Head banging is particularly distressing to parents. It occurs in 5 to 15 percent of normal children. Rates of up to 80 times per minute may be observed. It is reported to occur up to three times more frequently in males and may be associated with low socioeconomic status. Head banging can result in significant injury. It can arise in association with otitis media or teething.
Self stimulatory behavior including head banging may occur in autism, mental retardation, and in children who are neglected or abused.
I am not aware of any effective intervention. Any attempt to extinguish an unacceptable behavior in a young child is best accomplished by providing an acceptable substitute and praising or positively reinforcing acceptable behavior. If the child was previously neglected, attention to the head banging may positively reinforce it. On the other hand, ignoring the child will not eliminate his need for stimulation, therefore the best approach would be to make an effort to provide the child the best attention when he is not banging his head and try to gently interrupt the head banging and provide a substitute without giving prolonged attention in response to the head banging. When used as a response to frustration, the foster parents should make an attempt to help the child cope with the source of his frustration, but if it is essentially a tantrum, it is best ignored. In that situation, the child should be placed where he cannot injure himself such as a soft mat. It might help to have a soft helmet made for him which the parents can put on him if he starts to bang his head.
I'm not aware of any good sources of information about the affects of maternal drug use on their offspring. You might find useful information in a neonatology text. The following web sites had some information:
Sincerely,
Dr. Warren
-Kathy
Dear Kathy: Children under 5 years of age are at greater risk for kidney damage from a UTI. This would be especially true if the child has reflux, i.e., if, when he child urinates some of the urine gets pushed back up the ureters to the kidneys. There is also a greater risk that a young child who has a UTI has it because of reflux. The VCUG is done by placing dye into the bladder with a catheter and taking x-rays as the bladder empties. The purpose of the VCUG is to check the status of the ureters and look for reflux. If there is reflux treatment recommendations are specific based on the degree of reflux. The VCUG is an important test.
The renal ultra sound is similar to the ultrasound studies done on pregnant women to check their babies. It is done to check for certain kidney abnormalities which would increase the risk of UTI or kidney damage. It is an especially useful test to look for obstruction of the kidney causing hydronephrosis.
If a person reaches adulthood without a UTI, he is not likely to have an abnormality of the urinary tract. The likelihood of abnormalities of the urinary tract is higher in young children who have a UTI.
Sincerely,
Dr. Warren
Thank you.
-Angie
Dear Angie: Thrush is a yeast infection in the mouth. It is common in infants. It is a nuisance, but is not dangerous. You cannot catch it just by being in the same room with it, but it can spread easily among infants if they share bottles, pacifiers, or toys that they put in their mouths. Thrush cannot cause diabetes. The association between thrush and diabetes is that diabetics are more susceptible to yeast infections than non-diabetics.
Sincerely,
Dr. Warren
-GS
Dear GS: There is no physician who specializes in sides. Most specialties deal with organ systems or specific kinds of diseases. If it seems that your son's pain is not coming from his gastrointestinal tract, his doctor must consider whether he should see a kidney specialist if the pain is from your son's kidneys, or an orthopedist if the pain is muscular or skeletal. Depending on where the pain is localized the cause could even be neurological such as post-herpetic neuralgia from shingles. I am assuming your son's pain is abdominal since you are seeing a gastroenterologist. Without more information about your son's symptoms and the evaluation that has already been done, I cannot advise you further. You need your son's pediatrician to coordinate his evaluation with appropriate specialists.
Sincerely,
Dr. Warren
Thank you.
-Shannon
Dear Shannon: Blankets over children's faces generally don't pose a risk, but a lot depends on how heavy the blanket is and how easily the child can move his head under the blanket. Many parents solve the problem by putting their infants in blanket sleepers (essentially heavy pajamas) which move with the child and cover everything except the hands and face.
Sincerely,
Dr. Warren
Thank you.
-Shannon
Dear Shannon: I'm not aware of any study on differences between caloric content of human milk. While the basic ingredients in all human milk must be the same, humans, unlike cows, have a fairly varied diet, and their milk will vary with their diet. The differences in the milks you have seen may also depend on how and when they were pumped. The hind milk (the milk the baby gets after nursing for a while) has a higher fat content, and therefore higher caloric content, then the milk that comes out when the baby starts to nurse.
The baby's weight gain may be affected by how much milk the baby gets. If you're producing a large amount, the baby may be getting a lot of calories in a short time of nursing. In comparing him to other babies, even at this young age some children use calories more efficiently than others or are less active and so gain weight more easily. The baby's weight compared to height does not yet indicate a problem, but if his height remains in the 50th percentile and his weight shoots well above the 95th percentile, you may have to consider strategies for decreasing your son's intake.
Sincerely,
Dr. Warren
Sincerely,
-JA
Dear JA: The possible causes for a low white count range from laboratory error, to response to a recent virus infection, to normal for your child (since it was reported to you as "borderline"), to a variety of blood diseases including leukemia (a diagnosis which cannot usually be made from the blood count alone). Without seeing any numbers I cannot tell you the significance of the test results. Given the borderline nature of the test, if your child has been healthy, it is probably not serious or even significant, but should be repeated for confirmation and to determine if the count is stable, and if not, which way things are going.
Sincerely,
Dr. Warren
-BL
Dear BL: Young infants can get sinus infections; however after two days of cold symptoms with fever that is an unlikely diagnosis. Upper respiratory virus infections do cause the symptoms you describe. Depending on a child's exposure to these viruses (day care, siblings, school) it is not extraordinary to have 6 to 12 such infections a year.
The diagnosis of a sinus infection should be considered in a child who has had persistent cold symptoms for 3 or more weeks or who has pussy material draining from his nose or down his throat (not thickened green mucus in the nose which can be seen as a cold starts to dry up).
For more information check my article, Upper Respiratory Infections (URIs).
Sincerely,
Dr. Warren
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