11 December 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
-SM
Dear SM: Most virus infections run their course within 3 to 5 days. Since many of these illnesses cause fever, it is perfectly reasonable to give such an illness time to run it's course without seeing the doctor as long as the child does not seem very ill or have any worrisome symptoms. The problem is that some serious illnesses such as pneumonia and meningitis also cause fever and may make a child deathly ill if not diagnosed and treated quickly. Therefore, you must depend on your experience as a parent, your knowledge of your child, and your level of concern about how ill your child seems or any specific worrisome symptoms in order to decide when to see the doctor.
Symptoms which demand immediate attention include headache with stiff neck, uncontrolled vomiting, extreme pain, extreme irritability, extreme lethargy, rapid breathing, labored breathing, inability to drink, lack of urine output, and any other worrisome symptom you don't feel comfortable about with your experience as a parent. The words extreme are subject to interpretation. Most children with fever are somewhat more lethargic and irritable than usual, but more lethargy or irritability than you've seen with other illnesses should raise your level of concern.
For more information about fever, please read my article, Fever.
Sincerely,
Dr. Warren
-KH
Dear KH: I am not sure what you mean when you ask, "Is this developmental?" Stool withholding is not a normal part of being a toddler, nor does it necessarily improve just because a child gets older. Even though you don't say that your son has bowel accidents, you should read my article, Fecal Soiling as well as any letters in previous "Ask Dr. Warren" columns about soiling or encopresis. The problem of stool withholding is discussed in those columns and letters.
Sincerely,
Dr. Warren
-JB
Dear JB: I am happy to try to answer your question, but both you and your daughter are likely to get the most useful information from the baby's pediatrician since she is the one who has examined him and has some concerns about him. It's not uncommon for parents who are upset to leave the office without having all their questions answered. Your daughter should not hesitate to call the pediatrician and ask her questions. I'm quite certain the pediatrician will be happy to answer them. That's part of her job as your grandson's pediatrician.
If the baby's head is too big and growing too rapidly, the pediatrician could be concerned about hydrocephalus, a condition in which excess fluid collects around the brain. Treatment requires neurosurgery to place a shunt. If treated early, infants with hydrocephalus should grow to be normal adults.
If the fontanel is closing unexpectedly early the pediatrician could be concerned about craniosynostosis, a condition in which one or more of the growth lines of the head fuses prematurely. This causes the head to be misshapen and could cause the head to look too big, but the problem with premature closure of growth lines is that it actually limits the growth of the skull putting pressure on the brain. Treatment is surgical, and if done in a timely fashion should result in a normal looking head and a normal brain.
Putting all the features together - large head, small fontanel, almond shaped eyes - the pediatrician could be thinking of some syndrome, but without seeing your grandson I couldn't hazard a guess as to which syndrome or offer a prognosis.
Sincerely,
Dr. Warren
-Worried Mom
Dear Worried Mom: The key to your problem is that you say your daughter is always biting the same kid. Why is she doing that? There must be something going on in their interaction which is continuing to provoke your daughter's behavior. I'm not talking about blame. But it's time to figure out what provokes the biting attacks. Keep a close eye on them when they play together and be prepared to remove your daughter immediately from situations in which she bites BEFORE she bites. Your daughter is acting on impulse in response to something. Regardless of the fact that her impulse is inappropriate and unacceptable, she doesn't have the self control to ignore her impulse even with the threat of punishment. Therefore you must observe her carefully enough to intervene before she bites so that she will learn to step back and cool off rather than bite. If she does bite she must be removed from the play situation immediately - no second chances. If you cannot get the biting under control with this child, they must be kept separated, even if you and the child's mother are visiting each other.
Sincerely,
Dr. Warren
-W
Dear W: Sweating is normal. It is part of your body's mechanism for cooling off. That's why you sweat more when it's hot or when your body produces heat from physical activity. Some people sweat more than others. If it causes a problem with wetness, Mitchum is a very effective antiperspirant. (Antiperspirants keep you dry. Deodorants control odor.) For more extreme wetness, talk to your doctor about a prescription for Drysol.
Sincerely,
Dr. Warren
-Matt
Dear Matt: You are describing stretch marks. They occur in areas where the skin stretches from rapid growth, especially from rapid weight gain or from putting on muscle. They are nothing to worry about. With time, the redness decreases, but the stretch marks do not go away.
Sincerely,
Dr. Warren
-JM
Dear JM: Separation is difficult for a 2 year old, but survivable. It is also an excellent opportunity for her to get to know her grandparents and for them to get to know her; however, since she has only seen them twice in her 2 years of life, they are strangers to her. I would urge you, if possible, to have her grandparents spend a few weeks with you so she can get to know them in your presence before you leave her in their care.
Has your daughter ever experienced separation from you? If not, some experience with baby sitters before your trip would help her to learn to be away from you, and to learn that you do come back.
In addition, even though she may not appear to understand, talk to her about the trip. Plan to be in touch with her by telephone every day and tell her you will be. If she has no experience with the telephone, let her get some experience with it before you leave.
The rest depends on your daughter's personality and her response to strangers. She could be just fine, totally freaked out, or somewhere in between.
Sincerely,
Dr. Warren
Thanking you in advance.
-PA
Dear PA: The first question which must be explored is "How accurate is the conclusion that your son has a leg length discrepancy?" If the conclusion is based on symmetry of skin folds or even length measurements from one bony prominence to another it may not be correct. Generally accurate measurements require a special x-ray (a scanogram) or a CT scan.
Your doctor is right that no corrective action should be taken now. A 1 cm. difference in leg lengths may not be clinically significant. A minor leg length discrepancy can be treated with a lift in the shoe of the shorter leg if necessary, necessary being defined as: the leg length discrepancy causes an abnormality of gait or significant compensatory scoliosis with back pain. The only other treatments are surgical to lengthen the shorter leg or shorten the longer leg. The correct treatment depends on what is causing the leg length discrepancy. In addition, without a diagnosis, it wouldn't be possible to predict whether or not the discrepancy will increase with growth, and if so, how much. Therefore both the timing and the nature of any intervention requires a diagnosis.
Humans are not entirely symmetrical. A small difference in leg lengths requires no intervention or evaluation, but if there is any concern, you should consult an orthopedist.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
