25 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
In case you were wondering why I didn't ask my own pediatrician, the answer is, I could only get through to the nurse and she had no idea.
Thank you for your time!
-BM
Dear BM: Within a week I would expect all the chicken pox lesions to be scabbed and many of the scabs to have fallen off. At that point there is no reason they can't get wet, therefore swimming should not be a problem. Fresh chicken pox marks will not tan, so be sure to use a high spf sunscreen (minimum 15, preferably higher).
Sincerely,
Dr. Warren
Please reply.
-JM
Dear JM: Epiglottitis really is only minimally similar to croup. Children with epiglottitis are acutely ill with high fever from the infection. Within a matter of a few hours after the onset the illness progresses to the point where the airway is completely obstructed resulting in death unless the child is successfully intubated or has a tracheostomy. Fortunately, the HIB vaccine has virtually eliminated this rare, but serious disease since it is caused by infection with Hemophilus influenza b.
One likely cause of your son's loss of appetite is that steroids can upset the stomach. Within 2 to 3 days of starting the steroids the croup should be sufficiently improved to discontinue the medicine. If it is not further evaluation is warranted. If your son's appetite doesn't improve after discontinuing the steroids (perhaps with the help of Children's Mylanta), or his croup has persisted, or he seems ill, he should be rechecked by his doctor.
For more information about croup, read my article, Croup.
Sincerely,
Dr. Warren
-Kim
Dear Kim: While it is true that kids who are hypothyroid tend to be overweight for their height, the most important feature of hypothyroidism is that it causes growth failure. Hypothyroid children are short. Unless your daughter's growth curve shows an unexpected slow down in her rate of growth (height) it is not likely that she is hypothyroid.
If all your daughter's excess weight appears to be in her stomach, exercises to tone her abdominal muscles may help her appearance. In addition, make sure she is not bloated by constipation or excessive gas which may occur with certain foods.
For a clear understanding of the issues involved in childhood weight control, read my article, Childhood Obesity.
Sincerely,
Dr. Warren
Again thank you.
-JB
Dear JB: A lot has changed in the management of Down's Syndrome (also known as Mongolism) in the past 20 years. We know that with appropriate early intervention many of these children can grow up to lead productive lives. Most can be raised at home and provide great joy for their parents. The old approach of putting these children into institutions early on is, hopefully, a thing of the past.
The diagnosis of Down's syndrome has not changed in 20 years. It is caused by a chromosomal defect which can be diagnosed by a blood test. If the doctor caring for the child is not sure whether or not the baby has Down's Syndrome, the baby should be evaluated by a pediatrician, pediatric neurologist, or geneticist/syndrome specialist who can confirm the diagnosis or make the correct diagnosis if there is one to be made.
It is of the utmost importance to make the correct diagnosis early in any child who has any kind of syndrome including Down's Syndrome because it can help the parents anticipate and meet the baby's medical and developmental needs. Infants with Down's Syndrome may have specific medical needs related to heart defects and other medical problems. Early intervention programs which provide speech, occupational therapy, physical therapy, and special education should be started as early as possible for Down's babies.
Neither the description of a big head or almond shaped eyes would make me think of Down's Syndrome, but I can't tell you anything about the diagnosis without seeing the baby.
Sincerely,
Dr. Warren
Thank you very much for your reply.
-
Dear Nancy: I recommend that toddlers consume at least 16 ounces of milk (or the equivalent, including yogurt) each day. This assumes that there are other sources of calcium in the diet. Otherwise, to reach an 800 mg. per day RDA the child would need 24 ounces of milk. Calcium metabolism is finely tuned by the body so that it is not possible to overdose on calcium from a normal diet.
16 months is early to have all 20 primary teeth, but not unheard of. It has no special significance medically speaking.
Sincerely,
Dr. Warren
-LR
Dear LR: I am not aware of any situation in which nightmares have been described in 6 week old infants, therefore I would be most concerned that the baby's sleep is being disturbed by physical symptoms. Yes, babies can have prolonged crying fits and disturbed sleep from colic, but colic is generally evident early on rather than starting at 6 weeks. If all your concerns (spitting, crying, refusing to lie on her back) began right after the accident, they are most likely somehow related to the accident.
Unfortunately, most physicians including me, have very little knowledge about chiropractic. You would have to ask your chiropractor whether or not he believes all the baby's current symptoms are related to what he is treating. However.... equally unfortunately, most chiropractors are not skilled in medical diagnosis. In spite of some chiropractors' claims to the contrary, not all symptoms, diseases, or conditions can be explained by nerve compression or vertebral subluxation, nor can all conditions be treated by spinal manipulation. Therefore, if your baby has not had a thorough evaluation by a pediatrician to be sure what is causing her symptoms, you should consult your pediatrician right away.
Sincerely,
Dr. Warren
thanxs
-RE
Dear RE: All babies have some degree of reflux and spit. The dividing line between abnormal requiring intervention and further evaluation is not always clear, but is based on the baby's weight gain and any symptoms suggesting GI distress as well as the amount of spitting. If your baby is happy and gaining well, there may be no need to do anything more. If you wish to try a formula change you could either try a hypoallergenic formula like Alimentum or Nutramigen for possible formula intolerance, or you could try a thickened formula like Enfamil AR which will help with mild reflux. More severe symptoms related to reflux such as distress or poor weight gain require medical treatment and therefore, further evaluation by a gastroenterologist.
Sincerely,
Dr. Warren
1) is it safe to simply "sit back and wait" until age 2 to see if this progresses??Please understand, I am not a hypervigilant mom who typically goes outside of the normal loops to address any situation, but I have found my pediatrician to be often OVERLY conservative, and I fear that this may be the case now. I just don't want my daughter's health at risk with this "let's just see what happens" methodology. Please accept my thanks in advance for any time you may be able to spend responding to my question.. Your service and expertise are greatly appreciated.
2) does this sound like hydrocephaly to you??
3) what else could it be if not??
-KS
Dear KS: A large head does not necessarily mean hydrocephalus; however, that is clearly the most significant concern. If your child is developing normally and is not irritable, has not suffered any head injuries or meningitis, it is unlikely that she is suddenly developing hydrocephalus at 18 months. On the other hand, even if your most recent visit is the first to show your daughter's head size above the normal range, if her head growth chart shows a progressive growth across percentiles, it is time for further evaluation. The head growth chart is the key.
The down side to doing a CT scan of the head in an 18 month old is that it will very likely require sedation or possibly anesthesia. In the old days we used to do ultrasound studies of the head to measure the size of the ventricles (which would be enlarged with hydrocephalus). These measurements could be taken without sedating the baby. Since the techniques for MRIs and CT scans have been perfected I haven't heard of ultrasound studies being used for evaluation of hydrocephalus. It may be an alternative, but usually isn't done after the fontanel closes..
Sincerely,
Dr. Warren
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