27 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
She has never acquired a good appetite for either baby food or table food. It seems she only wants her bottle - 2 per cent milk She is being referred to the Easter Seal Clinic for evaluation and we are greatly concerned. She will take a few bites to begin with and then seems to lose interest. She will eat crackers and cherrio-s. But obviously that will not sustain her. She has 7 teeth.
We don't know how to handle this situation and I want to help encourage my daughter and help my grand daughter. Your answer will be sincerely appreciated.
-MS
Dear MS: You haven't told me why your granddaughter has been referred to the Easter Seal Clinic, so I'm not sure how it relates to your current concerns. In fact, I'm not very clear just what your concerns are other than that your granddaughter has little interest in food.
Your granddaughter's current weight and height are both between the 75th and 90th percentile for her age, so she is obviously getting enough nutrition for good growth. Milk is a fairly complete food since it has fat, carbohydrate and good quality protein. Just as formula was sufficient to sustain your granddaughter's growth for the first 6 months of rapid growth, it can go a long way toward providing complete nutrition now. You should be aware that the American Academy of Pediatrics recommends keeping formula fed infants on formula for the full first year and then switching to WHOLE milk, not low fat or skim milk. Skim milk is appropriate after the second birthday.
If a baby is consuming enough calories for good growth just by drinking bottles, she is not likely to have much of an appetite for food. Although there is some risk that the baby will get less calories for a while if you limit her intake of bottles, the only way to get a baby who is attached to bottles to eat more food is to limit the bottles.
For more information check my articles Feeding Your Infant and Nutrition Without Tears. If your daughter does not have Web access you can print the articles for her.
Sincerely,
Dr. Warren
-DK
Dear DK: The reason for keeping a close eye on moles is that, while most moles will never become cancerous, most melanomas do arise from moles. Removing moles that are suspicious is a good way to make an early diagnosis of melanoma or prevent it. Melanoma is a deadly cancer which is curable if caught early. Since melanoma is almost unheard of in pediatrics, you don't need to be alarmed; however, since your son has a lot of moles, it might not be a bad idea (good preventive medicine) to have them checked annually by a dermatologist. This is especially true if your son falls into the high risk category of fair skin, red hair, and spends a lot of time in the sun, or gets sunburned easily.
Many dermatologists recommend removing moles that are present since birth since they have a higher risk of malignant change. The fact that they are "birthmarks" does not make them safer. Many babies have vascular birth marks (red spots) which disappear and are of no consequence, but a mole does not disappear, whether you're born with it or not.
You are wise to observe moles for growth or changes. Rapid growth, multiple colors, indistinct borders, irregular shapes, sudden or drastic changes in appearance or hair (loss of hair on a hairy mole, growth of hair on one without) are all signs of possible malignant change. That does not mean that all such moles are malignant, but once such changes occur, it is best for the mole to be removed and biopsied.
Sincerely,
Dr. Warren
- FL
Dear FL: The condition in which one or more sutures in the skull are prematurely fused is called craniosynostosis. Untreated craniosynostosis can cause a deformity of the skull. Since the skull cannot grow along the fused suture lines, it becomes misshapen. This also puts pressure on the brain. It may even result in the head not growing enough to accommodate brain growth. The treatment is surgical.
Sincerely,
Dr. Warren
The first several days after we brought her home from the hospital, she would wake up around 3 - 4 a.m. cry and have difficulty getting back to sleep. Other than this, she seldom cried and when she did, could be comforted rather easily. On the 6th day, she would begin screaming about 10 minutes after every feeding (formula - Similac w/Iron). This morning, I called the ped's office as soon as they opened. I spoke to a nurse and told her what had happened. She said it sounded like she was "colicky" recommended giving her gas drops after she had eaten. We fed her again after the phone call, and around 10 minutes after the feeding, she once again started screaming and crying. I called the ped again, and this time, they told me to try switching her to a soy formula. I tried this, and after her next feeding I thought everything was going to be ok. She was happy and alert after the feeding. However, approximately 1 - 1½ hours later she began screaming again. We have fed her three times since then, and she is still crying and gassy after her feedings. Also, she does not eat as much of the new formula (Isomil) as she did the Similac.
Does this sound like a problem with Colic, an allergic reaction to the formula, or something else? I read all the articles you had on your web site about colic. Should I stay with the soy formula or try a hypoallergenic formula such as Alimentum or Nutramigen? Today is the first day we have tried the soy, and it does seem to be helping somewhat. She has cried, but it is not the screaming she had with the Similac, but she is still very gassy. She does not have diahrea, and her stool looks normal from what I have read on your site and in other books.
Any recommendations you have would be greatly appreciated. I would also like to thank you for having a site like this.
-GS
Dear GS: In spite of a general consensus that infant colic and gas appear related, the cause of colic remains unclear. Since gas pains may be caused by formula sensitivity, it is reasonable to try a different formula. A child who does not tolerate a cow's milk based formula may do well, on soy, but since infants can also develop soy sensitivity, I usually use a hypoallergenic formula such as Nutramigen or Alimentum. An infant who does not respond to a hypoallergenic formula may have colic which is not related to formula sensitivity.
Most infants with colic outgrow it by 4 months of age. There are no truly effective treatments. Many of us have experienced walking the floors with our infants in order to calm them. Since all infants have episodes of crying and episodes of gas pains, deciding when further evaluation or intervention is warranted can be difficult. If your baby is miserable, crying a good part of the time, and appears to be in pain 1 to 1½ hours after each feeding, the baby may be experiencing pain from gastroesophageal reflux. All babies have some degree of reflux and spit up as a result, but if the baby has pain or is growing poorly as a result of reflux, there are medications which can help. For further evaluation, a consult with a pediatric gastroenterologist may be in order. You must make that decision with your pediatrician based on the degree of problem the baby is having.
Sincerely,
Dr. Warren
Thank you.
-Karen
Dear Karen: The relationship between ADHD, OCD, Tourette's, and other tic disorders remains unclear. Some kids with ADHD may have a predisposition to develop one or more of these disorders. It is known that Ritalin can increase tics and provoke tics in kids with Tourette's. There is no evidence that Ritalin can cause Tourette's. The PDR still lists Tourette's and tic disorders as a contraindication to using Ritalin; however research suggests that Ritalin can be used with caution in the presence of tics or Tourette's.
According to Kaplan: Comprehensive Textbook of Psychiatry, 6th ed., Copyright © 1995 Williams & Wilkins
Although stimulants can bring out or exacerbate tics as a reversible side effect, the previous suspicion that they might cause Tourette's disorder has not been confirmed. The high rate of stimulant history in Tourette's disorder was apparently an artifact of the high comorbidity rate, and some children with both ADHD and Tourette's disorder are successfully treated with stimulants, sometimes in combination with an antipsychotic. In some children the tics subside as the stimulant dosage is increased.... A child who develops tics (or has serious preexisting tics) should undergo a trial of clonidine.
Sincerely,
Dr. Warren
-Sandy
PS: You helped me out with my 5 year olds infected nevi... I did take him upstate to the hospital and paid for a specialist to see him despite the HMO... He did need to have it removed from his scalp.. He is fine but when said and done I should have done sooner... Also although hmo wouldnt allow for visit ..once a problem was identified they did cover having our child taken care of. Thank you for your insight and the little push it took to make me realize I need to be an active participant in my childrens' health care...Dear Sandy: If your son is using 30 Tylenol #3 each month, on most days he is not using more than 1. Since the duration of action is only 4-6 hours, that doesn't suggest an addiction. Still, your concerns about long-term use of narcotics for pain management are legitimate. Behavior management is an effective method for the treatment of migraine in some children and adolescents. Biofeedback and self-hypnosis are replacing pharmacologic treatment in some centers because of the undesirable side effects of drugs and the concern that some may produce chemical dependency. Now that your son is 13 he may be a candidate for medications which work to prevent migraine such as propranolol. He might also benefit from ergotamine which is specific for migraine and not useful for other headaches. Ergotamine is generally not useful in younger children because to be effective it must be taken at the first sign of symptoms.
After so many years, if your son's symptoms are getting worse, it would not be unreasonable for him to have a complete reevaluation. It might also be reasonable for him to have another CT scan or MRI to look at the size of the subarachnoid cyst and be sure that nothing new has developed. Even if you cannot go to the neurologist who was originally treating your son, if you have an HMO, they must have a neurologist. While a pediatric neurologist would be ideal, at 13 years of age your son could see an adult neurologist. Ask your doctor for a referral. It sounds like it's time for another opinion on your son's headache management.
Sincerely,
Dr. Warren
-RJ
Dear RJ: Platelets are involved in clotting. A person with a low platelet count may experience nose bleeds which are difficult to stop, cuts which bleed excessively, intestinal bleeding, easy bruising, etc. There is a serious risk of bleeding with very low platelet counts.
Sincerely,
Dr. Warren
-Scott
Dear Scott: The short answer to your question is "No."
The technology certainly exists to freeze embryos for later implantation; however, at 8 weeks, you are no longer dealing with an embryo. The process of cell differentiation into organs has already begun. At 8 weeks the fetus has many cells. I don't think the process of sustaining even a small fetus and bringing it back to life has been developed.
Consider also that the embryos currently frozen for later implantation were fertilized in vitro. You're talking about finding and removing a tiny fetus implanted in the uterine wall without damaging it. Consider that there isn't a 100% success rate at implanting embryos and carrying them to term. Therefore your fetus would not be guaranteed any future if it could be removed and preserved. Finally, given the religious, ethical, and emotional issues surrounding experimentation with human fetuses if the technology could be developed, there is a question of how or if it would ever be implemented and what the risks of birth defects would be if there was any risk of damage to the fetus.
Sincerely,
Dr. Warren
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