25 June 2007

1. Is Soda Pop OK for Kids?
2. Dehydrated Infant
3. Self Stimulation
4. Burning on Urination - Vaginitis
5. Toilet Trained but Has Accidents During Day
6. Bumps on Back of Tongue
7. Cough and Fever
8. Easy Bruising
9. Disclaimer

• Read Questions & Answers in Another Column

Is Soda Pop OK for Kids?

Is it good to give young children, under 3 soda pop, diet soda, colas, etc? What are the effects.

Thank you for your time.

-Barb

Dear Barb: Occasional soda, such as on special occasions, cannot hurt a child. That includes diet soda. I would not recommend that young children drink soda regularly. First, the consumption of sweets on a regular basis may encourage a sweet tooth as well as contribute to tooth decay. Second, sodas, especially colas, may have caffeine. Caffeine can cause irritability and disturb sleep. When taken regularly, even by children, caffeine is an addictive drug. Third, and perhaps most important (maybe I should have made it first), young children who develop a taste for soda may decrease their intake of nutritious beverages such as fruit juice or milk and may even eat less food if they drink enough soda. Once children get the idea that they can have something like soda regularly they can be very stubborn about drinking more nutritious beverages.

Sincerely,
Dr. Warren

Labs

Hb--9.6
TLC 13500
DLC P-36,L-56,m-4,E-0,B-4
CRP--negative
Micro-ESR -- 32
Blood urea -- 58 mgm

Thanks

-Dr. R

Dear Dr. R: I'm missing some important details to make a differential diagnosis. One cannot go by lab work and physical exam alone. Is the baby feeding well? Is she nursing? If so, is Mom producing milk? Is the baby vomiting or having diarrhea.

The infant in question has a high BUN and has lost 1/2 pound. Unless the baby has a primary renal disease causing an elevated BUN this baby is most likely dehydrated. The cause of dehydration has to be inadequate intake or abnormal losses. The history is crucial to determining whether poor intake or fluid loss is the primary factor. Additional history would be necessary to determine the cause of poor intake (such as inadequate breast milk or lethargic baby). If the baby has been feeding poorly, at 28 days of age she could be septic even in the absence of other findings.

The bottom line is that this is a sick baby who probably requires rehydration as well as further evaluation dictated by the circumstances of the baby's illness. I hope you have already admitted this infant for treatment if there was no improvement. Unfortunately, as stated on my web site, I cannot provide answers to urgent questions in a timely fashion. I only answer e-mail once a week while on the train to clinic. At other times I am too busy with my own patients. While I am happy to help any of my colleagues who would ask me a question, "Ask Dr. Warren" is intended to be a resource for parents, kids, and basically any nonmedical people. As I said in my previous response, I am not a professor and have no reason to believe that I am either more brilliant or more knowledgeable than any of my colleagues.

Sincerely,
Dr. Warren

I hope this is just a phase. Is there anything I need to worry about?

I appreciate your help!

Thanks.

-Cindy

Dear Cindy: Young children are very much into what feels good to them. Your daughter has discovered self stimulation. As she gets older, she will need to learn what is socially acceptable. Until then, your only concern need be that she doesn't hurt herself. If she puts any inappropriate objects on or in her vagina, you must tell her it is dangerous and stop her from doing it. Be firm, but not angry. She is not doing something "bad." She just needs to learn what is acceptable and what is safe.

Sincerely,
Dr. Warren

Thanks for your help!

-Laura

Dear Laura: While it is true that prepubertal girls do not get vaginal yeast infections, it does not mean that they don't get vaginitis. Vaginitis is an inflammation of the vaginal area caused by irritation or infection. It may develop as a result of improper wiping, underwear made from synthetic fibers, or bubble baths. To prevent vaginitis girls must wipe from front to back and dispose of the paper, taking a fresh paper for any additional wiping. Wiping back and forth or from back to front brings stool organisms to the vagina. Girls should wear cotton underpants or underpants with a cotton liner. Bubble baths should be avoided completely. Nonspecific vaginitis can be treated at home with sitz baths (soaking in warm water without soap) 3 to 4 times daily followed by application of a bland ointment like A&D or Vaseline.

Nonspecific vaginitis means inflammation of the vagina that has no specific cause, but there are specific infections which can cause vaginitis. Most are not seen in young children; however, if the symptoms persist your daughter will need to see her pediatrician. In addition, burning on urination may also be a symptoms of a urinary tract infection, so unless you are certain that her symptoms are the result of a vaginitis, she needs to see her doctor.

Sincerely,
Dr. Warren

Our problem stems from his problem of getting to the bathroom on time when playing with other children. He does not pee the bed, he has been toilet trained since he was 2 years and 2 months old. He seems to be able to get the morning bowel movement into the toilet without any problem. But, if he has a play date after school, or is visiting with the neighbours after school, no amount of asking him to go to the bathroom seems to get him there on time. I am desperate. I have tried making him go as soon as school is over, I ask as a reminder around his "usual" time. I have tried punishing him by not allowing him playdates for a week. I am at the end of my rope. Is he having some kind of power struggle with me? I have even threatened to re-instate Pull Ups. But to no avail. I would think that there is a physical problem, except at all other times of the day, there does not seem to be a problem. Help or send me to some one who can, thanks.

-Dianne

Dear Dianne: Your son may be engaged in some degree of power struggle with you, but it is more likely a power struggle within himself. He is at an age where he is trying to exercise maximum control over his body. He knows he can stay clean and dry. He knows he can use the toilet when HE wants to. He believes he can control his bowels and bladder until the very last minute when it becomes urgent. And he thinks that what he has to do is so much more important than spending time in the bathroom. He doesn't want to interrupt what he is doing for bathroom breaks. To get past this, frequent bathroom breaks must be built into his day. There are two requirements for success with this program:

1. Know your son's schedule and plan pit stops so they do not interrupt activities. Bathroom breaks should be scheduled during transitions between activities and must include the time before going to a play date or before the start of any new activity that he will not want to interrupt.
2. Don't fight any battles you can't win. You can make your son go into the bathroom, but you can't make anything come out of him. Praise his cooperation and praise him for trying even if he continues to have accidents. Once a child get used to the fact that the regular bathroom break is going to happens he will usually cooperate with using the toilet.

Sincerely,
Dr. Warren

-RM

Dear RM: There is a double row of large taste buds which form an inverted V at the back of the tongue. They will be more prominent if the tongue is inflamed. They are not usually visible unless the tongue is extended all the way out.

Sincerely,
Dr. Warren

-(unsigned)

Dear Parent: Your daughter may have nothing more than a cold, but unfortunately the symptoms of colds are similar to those of complications like bronchitis and pneumonia. After 5 days of productive cough and fever your daughter should be checked by her pediatrician.

Sincerely,
Dr. Warren

I appreciate your assistance.

-JT

Dear JT: There are a number of conditions which can cause easy (excessive) bruising. The one feature which can separate these diseases from the normal bruises of an active child is the location of the bruises. Deep purple bruises which show up on the chest, abdomen, or back with no history of injury suggest a more ominous possibility than the usual childhood bruises on the shins which result from falls and knocking into things as children run and play.

Disorders which cause easy bruising include inflammatory diseases which cause increased capillary fragility and blood disorders which result in abnormal platelet function or a decrease in the number of platelets. The list of possibilities is long so if you think your son's bruising falls into the category of abnormal bruising have him checked by his pediatrician.

Sincerely,
Dr. Warren

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