23 October 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
When my son was born everything got allright. When he was about 6 weeks old, we tested blood samples (he still looked a bit yellow, esp. the scleras) and found hyperbilirubinaemia 173 micromoles/l (12 mg/dl). Next week (about 7th week of life) we have found 167 micromoles/l. Then the problem started.
The child looks healthy and very happy. He is breast fed. He eats well, sleeps well, When I talk to him, he smiles. Healthy child.
Our pediatrist recommended administration of Phenobarbital, for one week. Alternatively, they recommend to stop the breast feeding for 3 days.
I have surfed the web a lot and came to the conclusion, that this is unnecessary or dangerous for the child. I think that better for him is to wait until the bilirubin level drops, without any treatment. Our pediatrists will not alow us to undergo phototherapy, because of the "side effects". I do not know any unavoidable and harmfull sideeffect of PT, but when I had asked the pediatrist about it, she was not able to answer me. I have lost my trust, I do dot believe our specialists... I think, they only want to treat the bilirubin level symptomatically, regardless of the childīs benefit.
Anyway, I think, that PT is unnecessary too, at this moment.
We have done the serology tests of the child, and the laboratory tests too. Liver is O.K., everything is O.K. Only - the child has very high level of anti HBSAg antibodies. The level in his 7th week was about "850 I.U." I have tried to find out, what it can mean, the laboratory was not even able to answer me if the I.U. are I.U./l or /ml or whatever. The "protective level of anti-HBSAg IgG" after an vaccination should be "100 I.U.". I do not know, if it correspondes to anything known in your laboratory world. As I have said, my wife is a surgeon and she could and most probably did pass the Ig to the child, because she had been vaccinated and most probably also met the hepatitis B virus in some of her patients and got reimunised. The child is healthy, he does not suffer from any hepatitis and his mother is healthy too.
Please, Dr. Warren, could set my mind in peace? Would You start a treatment of my child? Or Would You wait?
Thank You very much, very very much.
Sincerely Yours
-JD
Dear Dr. FA bilirubin level of 13.9 mg/dl or lower in a newborn is considered physiologic and does not require treatment. Persistence of jaundice in nursing babies is a well known phenomenon which also does not require any intervention. Since your son's bilirubin level is stable and has come down slightly, as long as there is no hemolysis as seen with blood type incompatibility, the baby's current bilirubin level should not be a concern.
Did the baby receive the hepatitis B vaccine? If not, and the hepatitis B surface antigen is negative, it must be immunity passively transferred across the placenta from mother. Additional antibodies are transferred by nursing. The level required to protect against hepatitis B is not an upper limit. Higher levels do not imply a problem.
As long as the baby is not becoming increasingly jaundiced, you can wait to see what happens.
Sincerely,
Dr. Warren
Thank you very much.
Sincerely,
-AB
Dear AB: If the swelling you're talking about has been present since birth, then you're probably describing a cephalohematoma, which is a common birth injury. Cephalohematomas are not dangerous and resolve on their own. If the swelling has developed recently, it may still be a cephalohematoma which has become more evident to you as it goes toward resolution and as your baby's face changes; however, I cannot tell you for sure what it is. Any 1 month old who develops an unexplained swelling should see his pediatrician.
Sincerely,
Dr. Warren
Thank you for your time.
-JK
Dear JK: Your granddaughter's problem is actually somewhat medical. She is experiencing anxiety symptoms. As a result of the "fight or flight" reaction her body is producing extra adrenaline. This causes her to be shaky. It is a physical reaction to anxiety which she cannot control. And now she has developed a secondary anxiety about her anxiety reaction.
Performers who experience these kinds of symptoms take medication to control them. That is an option, but before resorting to that in a child, I would try counseling with someone who can explore her anxieties and provide her exercises to desensitize her to anxiety provoking situations.
Sincerely,
Dr. Warren
-MD
Dear MD: Four soft to loose BMs per day may be a normal pattern in some babies. Often, the consistency of the stool can be improved by adding more fiber to the child's diet. Also, pay attention to the amount of fruit juice you baby drinks, because excess fruit juice may cause diarrhea.
If you child has a reasonable appetite and is now gaining well along his current growth curve, and additionally seems content and not having abdominal pains, that may be all you need to do. If your child seems ill and is not doing well, then you should consult a pediatric gastroenterologist.
Sincerely,
Dr. Warren
She is not a very good eater. Some days, I'm lucky to get one meal down here in a day. The doctor has told me to try to get her to eat more fruits and vegetables, but that is sometimes a real challenge. Currently, she weighs about 31 lbs. The doctor says that her weight gain is normal. I have no problems getting her to drink milk, but juice is sometimes a struggle. I have not really tried potty training yet, because her bowel movements are so unpredictable. And I really do not think that she is ready yet.
When she was an infant, she did end up tearing the outer opening of her rectum. I'm not sure if she had a rectal examination then, but I know that there has not been one done since that time. I'm not sure if I'm overreacting or if there is a serious problem that the doctor is overlooking. She still has the scar tissue from that tear. I even wonder sometimes if I should take her for a second opinion.
I hope I have given enough information for you to be able to tell me what you might think may be the problem or if you have ever heard of anything like this before.
I look forward to your reply.
Thank you.
-Andrea
Dear Andrea: It does sound a bit odd that a child whose stool was hard enough to cause a fissure and who appears to be struggling to have bowel movements (or perhaps hold them in) is having soft stools. It certainly might be a good idea to do a rectal exam to be sure that she does not have impacted hard stool which she is holding in with leakage of soft stool around it.
Nystatin is an antifungal cream. Unless your daughter has a yeast infection causing the rash in her diaper area, there is no point in using it. If your daughter has a diaper burn from liquid stool, the best bet is to change her as quickly a possible when she has a stool, use Cetaphil cleanser to clean the area and avoid using pre-moistened wipes, and use a heavy layer of Desitin or Triple Paste over the whole diaper area with each diaper change.
As regards her eating, many toddlers eat a smaller amount and variety than most parents think reasonable. Of course, if your daughter's intestines are full of retained stool, it will decrease her appetite. If that is not the case, be reassured by her satisfactory weight gain and read my article Nutrition Without Tears.
I hope I have addressed all your concerns. If not, please write back.
Sincerely,
Dr. Warren
-S
Dear S: Any time a child does not gain weight for a long time, there is a concern about why. Is your child's height increasing? Has he had any illness? Has there been a change in what he is fed and how he is fed? A child who has accepted what his mother feeds him may, when he gets a little older, start trying to make choices on his own and may assert his right to eat based on his own appetite. You child's weight is between the 10th and 25th percentile which is perfectly normal. This should be followed carefully by your pediatrician over the next 6 months to determine if there is any need for further evaluation. As long as his growth continues along the current percentile, there is little cause for concern. For more information on the subject of feeding toddlers, please read my article Nutrition Without Tears.
Pediasure is a nicely flavored nutritional supplement that could help with your concerns, but my caution is that if it's taken before a meal, a child with a small appetite may simply not eat his meal. If your child's picky appetite includes some meat, chicken, fish, or milk as a source of protein, you may be worrying unnecessarily about the amount he eats, so do read my article, Nutrition Without Tears. And please remember that your goal is not to make your son gain weight. Fattening him up will not make him healthy. As long as he gains adequately for his normal rate of growth and is growing normally, that is all that's necessary.
Sincerely,
Dr. Warren
-AF
Dear AF: The normal sleeping body temperature is lower than the waking body temperature. This is primarily due to the lower metabolic rate during sleep; however, the lower metabolic rate does require that the brain set its thermostat at a lower temperature. For most people, the temperature just drifts down naturally, but young children, who have higher metabolic rates than adults, often sweat when they first fall asleep in order to lower the body temperature. This is especially true if the body temperature is elevated by activity prior to sleep.
Sincerely,
Dr. Warren
My questions are:
-KL
Dear KL: Warts are caused by a virus. They can be treated at home with an acid material to melt them away. That is what Compound W is. If your daughter picks at the warts, the best way to deal with them would be to use a wart plaster to remove the warts so that the wart is always covered. You could also cover them with a bandage after applying a wart remover and letting it dry. If your daughter removes the coverings and picks at them any way, you have two choices:
Sincerely,
Dr. Warren
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