21 August 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
Thank you.
-SS
Dear SS: I apologize for the long delay in responding to your e-mail. Unfortunately, your e-mail was temporarily misplaced since it didn't come to Dr. Warren's mailbox. In the future, be sure to send your questions by clicking on the e-mail link on Dr. Warren's web site to ensure that your question goes to the right place.
The article you read was talking about craniosynostosis, a condition in which one or more of the growth lines (also called sutures or suture lines) of the skull fuses prematurely. In most instances, while the head may be misshapen, since it can continue to grow along the open suture lines, the brain is not injured. Craniosynostosis might be suspected if the head shape is unusual and if one or more of the suture lines (places where the bones come together) feels like a firm ridge. Most misshapen heads are not caused by craniosynostosis, but rather, by the baby lying preferentially in the same position, resulting in one part of the head becoming flattened. Flattening of the back of the head has become quite common with the current emphasis on placing infants into their cribs on their backs.
You need not make an emergency visit to your doctor, but since your baby should be due for a general check up about this time, when your baby is checked, share your concerns with your pediatrician.
Sincerely,
Dr. Warren
Any idea what would be causing this?
Thank you for your time doctor.
-H
Dear H: Usually humans (unlike cats and dogs) have just one color of hair on their heads, but that's not always the case. The most common variation is a white forelock, but even though it's rare, some people do have a patch of hair that's not the same color as the rest of the scalp hair. The color change most likely occurred due to a mutation in the color producing cells of the hair follicle, very much the same way a mole (nevus, beauty mark) develops. If there is no unusual change in the skin below, it's of no medical significance. If there is a mole underneath, it should be observed for any signs of malignant change, as should all moles.
Sincerely,
Dr. Warren
-CC
Dear CC: It makes sense for your son's snoring to get worse when his congestion gets worse because he has a greater degree of obstruction of his nose when he has increased mucus. As long as your son is not experiencing sleep apnea, there is no reason to worry about snoring or think of removing his tonsils; however, if his nose is chronically congested he could have enlarged adenoids. Does your doctor believe that allergies are the cause of your son's congestion based on his examination? If so you could use an OTC allergy medication like Benadryl. Benadryl can make kids drowsy, so if you don't need symptom relief during the day, it might be best to reserve its use for bedtime. As a general rule I try to avoid symptomatic relief medicines for nasal congestion in infants because of the side effects which can include irritability, hyperactivity, and drowsiness, but if the congestion is making a child miserable, the side effects might not be noticeable compared to the relief of symptoms.
Sincerely,
Dr. Warren
Thank you and Regards.
-Mrs. S
Dear Mrs. S: A final height prediction for a child can be made by averaging both parents heights with the girls usually being closer to their mother's height and the boys closer to their father's height; however, there are a lot of variables that can alter that prediction such as the timing of puberty, family growth patterns, and a combination of recessive genes which could result in an unexpected growth pattern.
I am not aware of a wrist measurement used for predicting height. A wrist x-ray can be used to determine the bone age, a measure of skeletal maturity. The bone age gives a physician who is evaluating a growth problem an idea if skeletal maturity is delayed or accelerated. This information helps to decide what evaluations should be done and how much growth potential remains.
Rapid growth occurs during puberty. A delay in the onset of puberty will increase the gap between a short child's height and the heights of his peers, but in the end will allow for a longer time to grow resulting in a greater final height.
There are no physical activities which can increase height; however, excelling at an activity is great for a child's self esteem. Self esteem issues can be important to a short child.
If your child is maintaining a normal growth rate (something which should be checked at each checkup), then there is no reason to be worried. If her growth rate is not normal, then your doctor should proceed with an evaluation for short stature. There is no point in worrying about whether a child will succeed in being taller than his genetic potential since you cannot change that. Each child must learn to love himself as he is. Parents can aid by helping a child to find his strengths rather than focusing on his perceived shortcomings. Sometimes our strengths come form the way in which we are different from the norm rather than in how we are the same.
Sincerely,
Dr. Warren
-CM
Dear CM: Your nephew's penis is buried in the pubic fat pad. This is not an abnormality, but simply related to the size of the pubic fat pad. Unless he is obese as a child, his penis will no longer be "in" by school age. With the growth of his penis in puberty he would have to be morbidly obese for the penis to remain buried.
Umbilical hernias often close by 3 years of age. There is no medical reason to do surgery, so it should be left alone. If it doesn't close on it's own surgery can always be done electively for cosmetic reasons.
Sincerely,
Dr. Warren
Thank you.
-Susan
Dear Susan: I'm sure if you've been in a home where people smoke you're aware of how the smell lingers in the draperies and furniture. That does not mean that there are any impurities in the air, but you're wise to be concerned and consider the following:
Sincerely,
Dr. Warren
Can hearing loss be purely psycological? I KNOW the hearing aids gave her a new lease on life!!!
Thank-you.
-IP
Dear IP: Hearing loss could be psychological, but it seems unlikely that a profound loss which benefited from hearing aids would be. More to the point, if the hearing aids helped her, even if they were a "crutch" it would be foolish to deny her the aids while her psyche was getting the help it needed. Finally, consider that the second hearing test could have been in error. When I was a kid I remember hating film strips in the classroom because I couldn't read them. My parents took me to have my eyes checked and were told that everything was normal. The next time my eyes were checked it turned out I needed glasses. Once I had the glasses reading from film strips was no longer a problem for me. Obviously I needed the glasses the first time.
If the girl's problem revolves around insurance, since you have two conflicting opinions you should not only insist on a third opinion, but also point out that the benefit she derived from the hearing aids is likely to be less expensive than years of evaluation and therapy without the aids.
Sincerely,
Dr. Warren
Thank you for your time.
-Emma
Dear Emma: This is too important a question to be answered by a doctor who hasn't seen your son. By two years of age children should have a large vocabulary and be putting words into phrases. Since your on appears to have language delay and tight heel cords could be related to neurological injury, your son should have a thorough evaluation by a pediatric neurologist.
With regards to other treatments, if your son's Achilles is indeed short, surgery may help. An orthopedist should be able to advise you. Physical therapy could provide significant benefit. So might speech therapy considering your son's language delay. Regardless of whether the question of brain damage can be resolved, your son should be evaluated for early intervention services.
Sincerely,
Dr. Warren
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