2 October 2006

1. Head Banging Tantrum
2. Geographic Tongue
3. No Tears
4. Tingling Hands and Feet
5. Prefers Pink
6. Itchy Foot Rash
7. Primary Complex Tuberculosis
8. Refuses Pills
9. Disclaimer

• Read Questions & Answers in Another Column

Head Banging Tantrum

-(unsigned)

Dear Parent: A toddler's banging his head on the floor to express anger and frustration does not indicate that anything is wrong with him. The only thing you can do is to make sure he isn't on a hard enough surface to hurt himself (cement, ceramic tile). Avoid reacting to it by giving him his way or catering to him to avoid tantrums as this will encourage him to continue banging his head to get what he wants.

Sincerely,
Dr. Warren

I would like to know how I can prevent it from inflaming and any dietary information which would benefit me. Eating fruits with a high acid content, chilli, tomatoes and other foods seem to make it worse. Any information you have on this subject would be very helpful, as there is little information on the subject.

Please, please help!!!

-JT

Dear JT: Geographic tongue, which also goes by the name "benign migratory glossitis," is considered a normal variant. Those of us who get it, including me, are aware of the fact that it results in raw areas which can be sensitive to certain foods. To the best of my knowledge, there is no treatment or strategy to eliminate it. When your tongue feels sore, you just have to stay away from things that aggravate it.

Sincerely,
Dr. Warren

He does have a blocked tear duct in his right eye. He has had it since birth, but it has cleared up 2 or 3 times for a couple weeks at a time, only to return again. His pediatrician said to wait is first birthday to see if it clears up by then. So that only concerns me a little right now. I have seen his eyes water when it is very cold out, or when he has a cold sometimes he has had the "watery eyes/runny nose" symptom.

Is it unusual that my son does not shed tears when he cries? Should I be concerned? Could this be a sign of a bigger problem?

My son does not see his doctor for his 9 month check-up for 2 weeks yet, so I really need some answers. Thanks for all your help.

-Lori

Dear Lori: I am sorry I could not answer your question before your son's checkup. I trust that your pediatrician has confirmed that your son is in good health.

Most newborns do not cry tears. Tearing with crying usually develops during infancy; however, some kids scream instead of cry, and may not have tears with their screaming. There are conditions associated with a deficiency of tears; however that will result in dry eyes. As long as your son's eyes are not dry, his lack of tears with crying is not a cause for concern.

Sincerely,
Dr. Warren

-CF

Dear CF: Paresthesias (pins and needles) have been described in less than 2% of patients receiving Lipitor. As these may occur in patients who are not taking Lipitor, this is not evidence that Lipitor caused the symptoms. As a pediatrician, I have no experience using Lipitor, so you'd have to check with your doctor whether or not it would be worth trying a different medication.

Paresthesias can result from problems with peripheral nerves and from variety of medical conditions. Since you may have a treatable medical reason for your symptoms, you should see your doctor.

Sincerely,
Dr. Warren

-TM

Dear TM: You might find some information about color preferences in a child development text. I could not find anything about childhood color preferences in the recent literature. One study on color preferences indicated that it was both cultural and regional. Another, studying a different population found no cultural influence. A third study concluded that color preferences were affected by the menstrual cycle.

Each of us has individual preferences which make up our personalities. How much is an inborn accident of genetic combinations and how much is influenced by environment and psycho-social issues is not always clear.

Perhaps your son's interest in pink is sparked by the paucity of pink in his environment. If you were asked your favorite color, you could probably pick one or two, but if you were asked why, this is one preference for which most people cannot provide any explanation. For what it's worth, my opinion is that your son's preference for pink may be an interesting issue to explore, but it doesn't indicate any psychological, physical, or developmental issues which need to be addressed.

Sincerely,
Dr. Warren

Thank you.

-(unsigned)

Dear Sixteen: The two main possibilities are that you have a fungus infection of your feet, or that you've developed an inflammation of your feet from moisture due to sweating. Either way it would be best for you to make sure your shoes and socks are dry, and powder your feet before you put them on. If your feet sweat a lot, you may need to change your socks in the middle of the day and have a spare pair of shoes so each pair can dry out for a day before being worn again.

You can try an antifungal cream like Tinactin, Micatin, or Lotrimin, but if your feet are very inflamed, you may need a prescription cream. Do your parents know about your rash? At sixteen years of age you should be letting your parents decide if you need to see a doctor.

Sincerely,
Dr. Warren

Thank you very much

-Max

Dear Max: Primary tuberculosis (also known as primary complex, also referred to as latent TB in the US) is diagnosed when a child has a positive skin test for tuberculosis and no evidence of active disease (negative chest x-ray, no other symptoms or findings of TB). When the tuberculosis bacteria enters the body of a healthy individual, rather than developing disease, most of these people wall off the infection in a primary complex where it can remain inactive for the rest of that person's life. Such people are healthy. Their main risk is that the disease could reactivate during a period of stress, illness, malnutrition, or if treated with steroids. To avoid this possibility of reactivation tuberculosis, the patient is treated for 9 months with an antituberculosis drug called isoniazid (INH).

The child with primary tuberculosis is not contagious or ill. He can continue to participate in all activities and live his life just as before except that he must take his medicine every day for 9 months.

Sincerely,
Dr. Warren

- how to get him to take a pill;

- or how beter to disguise the medication in food.

-Tom

Dear Tom: I have no experience with Wellbutrin - no knowledge of its taste or consistency. Your best resource on ways the taste could be hidden is your pharmacist. Usually crushed (or whole) pills are best hidden in food like ice cream, pudding, or yogurt, rather than a drink. It may also help to set up a routine for taking the pill. Make it clear to your son that he has to take it, but let him choose what food to put it in and what to take afterward to get rid of the taste.

Sincerely,
Dr. Warren

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