26 June 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
Thanks for your time.
-Shawn
Dear Shawn: It sounds like your describing trigeminal neuralgia (also known as tic douleureux). The cause is not known, but the pain is being produced by irritation of the trigeminal nerve. The pain from trigeminal neuralgia does not extend to the back and chest; however, you may have had secondary pain from muscle spasms in response to the primary pain. You should consult your pediatrician who can refer you to a neurologist for evaluation and treatment.
Sincerely,
Dr. Warren
Thanks.
-(unsigned)
Dear Sir: Sometimes it is difficult to visualize a patient's problem from his description. If you have a pimple or cyst on your penis it may occasionally swell if it gets irritated. A large swelling which is painless could be a form of allergic reaction (hive). From your description, I doubt that it's anything serious, but only a doctor's examination can tell for sure.
Sincerely,
Dr. Warren
-DL
Dear DL: Children can have gall bladder disease, although it's rare except in children with hemolytic anemia and sickle disease. Stress can also be a cause of abdominal pain in children. Functional bowel problems including constipation are among the most common causes of abdominal pain. Certain infectious illnesses like strep throat are commonly accompanied by abdominal pain. If your daughter's pain has been a persistent problem rather than a few isolated instances associated with other illnesses, she will require further evaluation. There are plenty of tests which can be done which are not invasive: urinalysis, urine culture, blood tests, stool culture, stool for parasites, stool for blood, abdominal x-ray, abdominal and pelvic ultrasound. Depending on the circumstances, even an abdominal CT scan could be considered before doing anything invasive. If the pain persists you might consult a gastroenterologist. A consultation does not obligate you to any procedures.
Sincerely,
Dr. Warren
Thank you.
-Tracey
Dear Tracey: The first thing you must do is move your daughter's bed away from the window. If she could rock to the point of cracking the window in her sleep she could break the window and fall through causing serious injury. Rocking during sleep to this extent could indicate a sleep disorder or a seizure disorder. You should consult a pediatric neurologist. If the neurological evaluation is negative ask the neurologist to refer you to a sleep/wake disorders center.
Sincerely,
Dr. Warren
The times he has eaten well has been when he's skipped a meal that day or if we feed him for the first time say around 1:00 in the afternoon. He is about 44 inches tall and weighs approx. 40-42 lbs. Is this normal? Is there something we can do to encourage him to eat more.
I would appreciate it if you can offer suggestions or ways I could get him to eat more.
-BG
Dear BG: At 44 inches your stepson is a good size for a 4 year old. Given his height he is slim, but not underweight. I think the biggest problem is that meal time is a battle. No child ever learns good eating habits by having unpleasant mealtime battles about eating. You've already discovered for yourself that if your stepson misses a meal he's hungry and eats well at the next meal. Nutrition doesn't have to happen 3 meals a day, so take the pressure off, and if he doesn't want to eat just let him sit at the table and be sociable with everyone else until the meal is over. Just make sure that your stepson doesn't have the opportunity to substitute junk food for meals when he doesn't feel like eating his meal. For a complete discussion of this problem read my article, Nutrition Without Tears.
Sincerely,
Dr. Warren
-AM
Dear AM: I'm not aware of any studies on the subject of sleep and breakfast and their effect on school performance. I don't think it takes a study to tell that a child who is tired from lack of sleep will have difficulty concentrating. It is equally true that a child who is not adequately nourished will suffer intellectual deficits; however, the body's reserves are such that if a child is well nourished, I doubt that missing a meal before school could affect the child's performance, unless the child was hungry, in which case his mind would not be on his work.
Sincerely,
Dr. Warren
Thanks for any help you can give.
-JH
Dear JH: When an infant's interests switch from bottles to solids as a source of nutrition, the decreased fluid intake will cause a decrease in urine output; however, if a baby is eating well and happy, it is likely that his fluid needs are being met by his foods along with what he still drinks. Many foods have a high water content and provide a significant portion of a person's fluid needs. Thirst is a strong drive. As long as your baby is healthy, I'm sure that she will take what she needs as long as you make it available. If your baby is not eating well, then she needs to be checked by her pediatrician to determine what the problem is.
Sincerely,
Dr. Warren
1. He has woken up crying in a strange way 3 times in the last 2 months. Normally, if he wakes at night he will stand up in his crib and cry or scream to get our attn. The 3 times I am speaking of are different in that he just starts to cry a deep steady cry and when we go to his room, he is still on his back, covered up with his eyes closed. When we pick him up his shoulders are crunched and his head is back and he does not even realize that we are with him. He opens his eyes and has a blank look. After a couple of minutes, he takes a bottle and calms down, but the way he cries and acts is scary. Could this be nightmares??
2. He does not fall asleep on his own, and he wakes up 2-3 times per night and I have to go in and hold him in his rocking chair for a few minutes or give him a pacifier and then he usually falls back asleep. But sometimes he doesn't and I wind up bringing him into our bed. We live in a house w/ an apt. upstairs. The bedroom in that apt. is above our sons. The people get up at 5:30am to commute to NYC so letting him cry is not an option. However, we are having a house built in Florida and are moving in 5-6 months and I definately want to try your methods in the Helping Your Child Sleep....article, but will it work on a 15 mo. old toddler the same as an infant or is there a different approach I should take at that time?
-Staci
Dear Staci: The situation you describe indicates that your son is crying in his sleep. He does not respond to you because he is not awake. This could be caused by dreams (nightmares) or could be the result of not feeling well. If he is perfectly okay during the day, you need not be alarmed.
I applaud your consideration for your neighbors. Just be careful not to encourage bad sleep habits in your efforts to keep your baby quiet for the neighbors. Children can be taught better sleep habits at any age, but the longer a child has lived with an undesirable sleep pattern, the harder it is to change.
Sincerely,
Dr. Warren
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