17 December 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
We have never had him fully evaluated medically for this condition. Our pediatrician does not seem overly enthusiastic about sending him on to someone else for further examination of his delays. Our son has had a hearing exam through the school district, and he will see an ENT for recurring ear infections in May. My husband and I have mixed feelings about further examination of his delays -- as he is currently receiving services. But still we are worried that this is something we should do -- What do you think?
-JR
Dear JR: I also have mixed feelings about proceeding with any further evaluation of your son's developmental delays. After a complete workup, which could include EEG, CT scan or MRI of the brain, blood tests and urine tests to screen for metabolic disorders, chromosome studies, it is possible, even likely, that you will not come up with any underlying disorder. Even if you arrive at a specific diagnosis (which may give you some peace of mind) there may be no additional treatment besides early intervention services.
In most teaching hospitals (university hospitals) there are developmental specialists. A consultation with such a specialist could help you decide how far to go in evaluating your son's delays. While I'm not suggesting that you go full speed ahead with a major evaluation, I think the question will gnaw at you until you get the expert opinion regarding how much evaluation to do from a physician who deals with developmental delays.
Sincerely,
Dr. Warren
-AK
Dear AK: Since I did not examine your baby it is hard for me to be sure just where his congestion is. Often, when parents are concerned because they feel congestion in their babies' chests, they are really feeling vibrations which are transmitted to the chest as the baby breathes through upper airway mucus. I'm sure that if your doctor heard something in your baby's chest he would not ignore it; however, you need to ask your doctor to explain what is causing your baby's symptoms rather than just reassuring you or telling you that nothing needs to be done.
Infants can get mucousy from colds; however, persistent mucus from early infancy is often due to an effect of Mom's hormones on the nasal membrane. Noisy breathing coming from the throat may be due to softness of the windpipe (tracheomalacia) which resolves as the tracheal cartilages become firmer. Medications for upper airway mucus do not cure anything and can make babies very irritable, so generally pediatricians recommend using saline (salt water) drops in the nose and suctioning with a bulb syringe. A vaporizer may also be helpful, especially in the winter when dry air may irritate the nose and cause mucus to be thicker.
Problems in the chest (lungs and bronchial tree) generally cause significant coughing which you did not mention as part of your complaint. If, in spite of what I have told you, you believe that your baby has a problem with breathing, you might ask your pediatrician to refer you to a specialist such as a pediatric pulmonologist or ENT.
Sincerely,
Dr. Warren
Thank you for your time, and the effort that this site takes.
-HD
Dear HD: The fact that your son is very thin may account for his lymph nodes being easily palpable; however, even in a thin child supraclavicular nodes would cause me to be concerned. Add in persistent or recurrent fever and your son definitely needs a thorough evaluation.
Sincerely,
Dr. Warren
Thank you for your valueable time.!
-One Worried Grandma & Grandpa
Dear Worried Grandma & Grandpa: All drugs have the potential to cause adverse reactions and therefore should only be used appropriately (i.e., when the benefit outweighs the risk). Adderall has been tested and approved for use in children as young as 3, therefore, if your granddaughter has a reason to be on the medication it is wise to be on it.
Attention deficit disorder may occur without hyperactivity, so your observations of her behavior may not be sufficient to rule out the possibility. In addition, your expectations of her and the one on one attention you give her may be very different from what happens in school. On the other hand, I must admit that while these medications are used in young children, most children are not considered for the diagnosis and treatment of attention deficit disorder until their attention problems interfere with school, which, at least in the past, was not usually before first grade.
The decision to use medication for treating attention deficit disorder is usually based on a behavior rating scale such as the Conner's scale, and psychometric testing such as IQ testing. The behaviors being rated relate specifically to attention. The medication is not used to alter behavior.
Most children tolerate the medication very well. It is a stimulant and so may have side effects related to its stimulant properties such as palpitations, rapid heart beat, restlessness, tremors, loss of appetite, and high blood pressure. Effects on the central nervous system could include mood changes, dizziness, and movement disorders. Dry mouth, diarrhea, constipation, and allergic reactions have been reported.
Sincerely,
Dr. Warren
Thank you.
-LS
Dear LS: Ovulation occurs 2 weeks before menstruation. Your peak fertility is around the time of ovulation since sperm already in the genital tract can fertilize an egg when you ovulate and fertilization can occur within the days following ovulation. For the rhythm method to work, then, it would be wise to abstain from sexual intercourse for a few days before and after ovulation. The problem is, that menstrual cycles cannot be depended on to be regular, and the appearance of regularity caused by your taking the pill cannot be depended on to tell you when you are actually ovulating since, if the pill were working, you should not ovulate at all. Theoretically you should be safe for at least the first week after you start your next cycle of orthotricyclen, but if there is a chance that you are ovulating, my advice would be to use condoms or a diaphragm with spermicidal jelly until you have been off the minocycline for one cycle.
Sincerely,
Dr. Warren
She has had no problems with weight gain, and is a healthy, round 15lbs.
I have done extensive research on the subject, and am VERY wary of medicating her with Reglan because of the potentially serious side-effects. I am methodically trying to determine what I can do at home to help relieve my daughter.
-
P.S. Thank you for performing such a valuable service on the Internet! You are very much appreciated :)
Dear Michele: When we talk about using concentrate instead of powder, I just want to be sure that you are diluting it according to the manufacturer's directions. Feeding undiluted formula concentrate for any period of time is extremely dangerous. I must admit, I have no personal experience using either concentrate or powder since all of my children are adults, and we used a ready to feed formula when they were infants. Since the ingredients are the same in all 3 forms of formula, I am always amazed at the differences in consistency. In any event, if your baby does better on concentrate than powder, I would not let the changes in her stool deter you from using the concentrate.
If you are still trying to stabilize symptoms, it is probably wise to not reintroduce solids until you have settled on your formula.
While I don't suspect some other problem, such a persistent problem does cry out for a formal and more complete evaluation. I would suggest seeing a pediatric gastroenterologist.
Any effects from aminophyllin should be long past. I don't believe it has anything to do with the reflux. I don't know if reflux is more common in premies. It wouldn't surprise me if it was.
I have no knowledge about using erythromycin to treat reflux. Are you sure you didn't mean some other medication. Erythromycin is an antibiotic which may sometimes cause abdominal pain and vomiting as a side effect, hardly the thing to try for reflux.
My main advice would be to consult a pediatric gastroenterologist if you are not comfortable starting the course of Reglan recommended by your pediatrician.
Sincerely,
Dr. Warren
-Sara
Dear Sara: While there are proponents of cosleeping (the family bed), as you have experienced, it is not an acceptable long term solution for everybody. My advice remains never to start it as it becomes that much harder to put an end to it. There is nothing you can do to make a baby sleep or prevent him from awakening. The most you can do is provide him the opportunity to learn good sleep habits. For some kids it is much tougher than with others.
First, you should have your son checked thoroughly by his pediatrician to be sure there is nothing interfering with his sleep. Since he gets frequent ear infections, these could be part of the problem. Sleep habits developed over weeks to months can be undone by one night of ear pain. If your son is happy and healthy during the day, there probably is no physical cause for the problem. Then you must decide if you want your son in your bed or not. If you decide to get him out of your bed, do it, and DO NOT BACKTRACK no matter how difficult it is. Reread my advice. There is no quick fix. Stick with what you decide.
Sincerely,
Dr. Warren
My point is that I was in very critical phase and I was not able to walk for 3 months but then I was healed. However, I still have fever from time to time for no reason, no pain and no ache. So I was wondering if this bacteria from the scarlet fever could leave marks and effects on me forever?
Thanking you very much, Looking forwards to hearing from you,
-Hanna
Dear Hanna: Scarlet fever is caused by infection with a strain of streptococcus which produces erythrogenic toxin. Scarlet fever used to be a more serious disease before penicillin was available to treat the strep infection. In addition, the erythrogenic toxin has become milder over the years so that the experience you had with scarlet fever is rare. Since you have fully recovered, it is unlikely that your prior bout of scarlet fever has anything to do with your occasional fevers. If your fevers are frequent or persistent, you should see your doctor for an evaluation.
Sincerely,
Dr. Warren
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