10 September 2007
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
-PS
Dear PS: Many children have no teeth by their first birthday. If everything else is fine there is no cause for concern.
Sincerely,
Dr. Warren
-S
Dear S: Without seeing the rash I can only guess what you're describing. The hair follicles on the underside of the penis, especially by the base of the penis, are large, causing an appearance like chicken skin. The hairs may be fine so that some of the bumps have no visible hairs unless closely inspected. On occasion, a follicle may form an inclusion cyst with a build up of cheesy white material inside the bump. This is all normal and not worrisome.
Is that what you have? I can't tell without seeing it. I understand your feeling of embarrassment, but doctors examine private body parts all the time. If you have a problem in the genital area you should not let embarrassment stop you from getting medical attention.
Sincerely,
Dr. Warren
-Judy
Dear Judy: Any child who remains febrile while on antibiotics deserves a thorough reevaluation. If the child had a severe cough, the chest and back pains could be due to muscle strain. They could also be muscle aches related to a flu like illness. The question is whether or not this illness is something more serious which would benefit from a change in treatment, a decision which can only be made after a thorough examination and appropriate tests which might include a chest x-ray and blood work such as a CBC and ESR.
Any further action would have to be based on the examination and test results. Although Augmentin is an excellent and reasonably broad spectrum antibiotic, not all infections can be treated with it. In addition, more serious infections, even with organisms which are susceptible to Augmentin, may require intravenous antibiotics for effective treatment. If, for example, your granddaughter had a pneumonia which has not responded to the current treatment, hospitalization would be appropriate. Certain bacterial infections may result in collections of pus which require drainage for appropriate treatment. As physicians we can never afford to think, "the patient is covered by antibiotic treatment therefore there's nothing more to do."
I'm guessing that your granddaughter is taking Relenza for the flu. I have no experience using it. The usual course of treatment is 5 days. It is not a cure for flu, but does shorten the course and decrease the severity of the illness. To be effective, it must be started within 48 hours of the onset of the illness. It has not been shown to be effective in preventing complications. It is approved for use in children 7 and older.
Bottom line: I don't know how sick your granddaughter is or if she just has a flu like illness, but she should be thoroughly reexamined to be sure that nothing has been missed.
Sincerely,
Dr. Warren
I would really really appreciate your quick response.
Thanks a lot.
-Peter
Dear Peter: Forgive the long delay in my response. Your e-mail arrived while I was not accepting e-mail, as spelled out on my web site. Following that I had some medical problems myself.
Generally HIV is not transmitted through the mouth. The virus is destroyed in stomach acid. Theoretically, if there was a large amount of blood so that it came in direct contact with the membranes in your mouth, you could get infected; however, the HIV virus is also not likely to survive cooking, so if the blood in question got on the pasta before or while it was being boiled, again there would be very little likelihood of infection.
If you're living with a person who is HIV positive, it sounds like you need to agree on some ground rules. While the scenario you presented sounds like it has virtually no risk, if your HIV positive roommate would like to keep his roommates, you need to be able to trust that he considers anything contaminated with his blood to be infectious and that it will be disposed of in such a way as to prevent your exposure to it.
I'm not aware of any preventive medication being offered for such questionable exposures, but I'm not an AIDS specialist. There's no question that early treatment improves the outlook, so if you think you might have been exposed, you need to be tested.
Sincerely,
Dr. Warren
-JM
Dear JM: I have encountered many children whose weight percentile has fallen off in the first year. Most have a concomitant decrease in height percentile. Since your son has had a thorough medical and psychological evaluation I'm not sure that I can make any additional contribution. If the issue of tube feeding is looming I think you should consult a nutritionist who can help you maximize your son's caloric intake from the food he is willing to eat. The issue you mention with textures may be quite significant. This is usually dealt with by a speech therapist who has specialized in feeding problems.
Sincerely,
Dr. Warren
-Barbara
Dear Barbara: There are no internships available in pediatrics for those who have no professional training; however, many community hospitals have programs for students interested in medical careers. These are probably not paying positions. If you have not seen anything in your community newspaper, you will need to contact the community relations department or the administrator of your local hospital and inquire about their programs. This could include volunteer jobs in which you are helping out. You could also contact the personnel department to see if they have any part-time or summer jobs for students. Since you have no professional training in a health field, you might be looking to be an assistant in one of the programs for the kids on the ward (playroom).
You might also contact some of the physicians in your community to see if they have any job openings or know of any programs. Since you're interested in pediatrics, your own pediatrician might be an excellent person to point you toward programs in your community.
Sincerely,
Dr. Warren
Please write as soon as you can. she falls asleep crying now....
-RN
Dear : A child should be able to go to sleep without watching TV or listening to music; however, there is no harm in falling asleep to music or TV. When older children have difficulty falling asleep using music, TV, or reading to relax is one of the measures we recommend to help.
If your daughter could only fall asleep in your bed and you wanted her to sleep in her own bed, you would have to make the change and she would be upset for a while, but eventually she would get used to it. The same is true with regard to your daughter's falling asleep to music or TV. It may be difficult at first, but if you believe it is important, she can get used to it.
My bigger concern is the tension between you and your husband regarding child rearing and your belief that he would dictate when your daughter smiled or laughed if he could. That is a very strong indictment of the man who is her father and your husband. My guess is that you and your husband have adversarial views of your relationship with your child in which he thinks you're coddling her and you believe you need to protect her against him among other things. This can only lead to major grief for all of you and I strongly suggest you get family counseling.
Sincerely,
Dr. Warren
-Worried Parents
Dear Worried Parents: Breath holding spells may be frightening and generally occur in response to extreme crying. They may be seen as part of tantrums but can also occur if a baby gets very upset, for example, in response to pain. Therefore the reflux/colic could be triggering the breath holding spells.
My advice is to not be alarmed. The worst that can happen is the child will pass out and then resume breathing on his own. Infants only learn to use breath holding spells to manipulate their parents if the parents repeatedly respond to breath holding spells by placating the child in a way they would not in the absence of the breath holding. At 3 months I think a child is a bit young to learn to use breath holding spells, but the patterns of response set in motion now could lead to trouble in the future.
My additional advice is that if your infant has been diagnosed as having reflux and has a great deal of discomfort, you should talk to your pediatrician about treatment for the reflux.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
