28 January 2008
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
-Denise
Dear Denise: The removal of a testicle at 8 months of age does not have anything to do with a child's ability to be toilet trained. This is clearly a behavioral problem based on the fact that your nephew is also totally undisciplined. It is possible that the traumatic events surrounding the child's surgery as an infant resulted in his parents treating him as if he were fragile and had to have his own way. But it's also possible that the child has a neurological problem or a major psychiatric disorder such as childhood schizophrenia. His parents are not doing him a favor by accepting this behavior. The older he gets, the less acceptable your nephew's behavior will be in the real world. He may have all the power at home (which will not bring him happiness), but in school he will be the stinky kid that everyone makes fun of and avoids. The child needs a thorough evaluation by a physician and a psychologist.
I've assumed your nephew is in school. If so, how is he doing academically? socially? behavior problems in school? If he is not in school, what is the reason? I don't know enough about the situation to be sure, but if the child is not receiving appropriate care and schooling, then social services or the law should be involved. If he is in school, I suspect the school would take action about any obvious unacceptable behavior or constant toileting accidents.
Sincerely,
Dr. Warren
Note to Readers: Today's knowledge of autism might qualify this child's behavior to be considered part of autism spectrum disorder. I'd need to know more about his language development, eye contact, and interactions with others to know if that's a possibility.
Dear Dr. Warren: He does not go in his pants at school as far as I know. I think he holds it until he leaves. He only goes to school for half a day right now because he is in kindergarten. Do you have any ideas of how I can approach the parents on this? She seems to get mad if I bring it up. I think she thinks I am talking bad about him, which I am not trying to do at all! He gets in trouble at school alot, from what I have heard. I know even the principal has called the home. Do you know a good way to discipline him, as he has never been disciplined yet. Thanks
-Denise
Dear Denise: There is no good way to bring up a subject people don't want to hear. And while I do have some advice on discipline which can be found among my articles, the child's parents have to be interested in having the advice since you are not in a position to provide the child consistent discipline. The best advice I can give you is to maintain a loving and involved relationship with your nephew and his family so that your concern is evident and will not come across as criticism. The mother's sensitivity on the subject probably indicates that she knows something is wrong, feels hopeless or believes she is doing all that can be done, and resents the well meaning advice of people she feels don't understand. She needs to understand that changing her approach does not constitute admitting guilt or accepting defeat. You can only help her see that if you are a friend. When you hear that there is trouble be there to provide support. Rather than offering your opinion, ask Mom what options she has considered and what she would like to do. Present your ideas by asking what she would think about.... or how she would feel about.... When Mom concludes that your idea is good, remember it is her conclusion. Never take away her sense of accomplishment or control by pointing out your role or claiming credit. It will not help you influence her later to do so.
Sincerely,
Dr. Warren
Thank-you for your time.
-John
Dear John: If your 6 year old's testes are fully descended into the scrotum, the size of the scrotum is not important. When a child has undescended testes, the scrotum may be almost flat. The size of the scrotum may vary with room and body temperature as the testes will pull toward the body when your son is chilled and will move away from the body when he has a fever.
The scrotum of a newborn tends to be larger than a young child's because of the influence of maternal hormones to which he is exposed in the womb. This effect decreases gradually over time. After that, even though the child continues to grow, there is no appreciable growth of the genitalia including the scrotum, until puberty.
Sincerely,
Dr. Warren
-KM
Dear KM: Abnormal hair may be caused by a variety of conditions. If your granddaughter's thyroid has not been checked, perhaps it should. Usually the first clue to thyroid disease in young children is its effect on growth.
Since hair is a skin appendage, dermatologists are the experts at diagnosing congenital and acquired abnormalities of hair. I would suggest consulting a pediatric dermatologist.
Sincerely,
Dr. Warren
-Sandy
Dear Sandy: There are no diets which target specific areas of the body. Most often the appearance of flabby areas in a person who has successfully dieted is a result of poor muscle tone. This is usually most evident in the abdominal muscles and on the back of the arms because gravity makes these areas hang. The best thing to do is exercises aimed at toning these muscles.
Sincerely,
Dr. Warren
-Jennifer
Dear Jennifer: Often the cause of hives cannot be pinpointed because allergic reactions occur to things previously tolerated (in fact, prior exposure is required for the sensitization which causes the hives), and reactions may occur weeks after the exposure. Hives may occur in response to infectious illnesses, medications, foods, and environmental exposures. While I've also heard that stress can cause hives, I have never seen it in practice and am not aware of any studies linking hives to stress in infants.
In any event, life has its stresses. You cannot backtrack on the decisions you make about what is in your son's best interest if he develops hives. My advice is to forget about the pacifier and let your son do the same. If you give it back now you will have an even harder time getting rid of it later. Given the way hives can come and go, you'll never be certain about the role of any specific stress, even if we accept the idea that stress causes hives in toddlers.
Sincerely,
Dr. Warren
-CC
Dear CC: If the child's rash had been resolving with the treatment given, it may take up to a year for the discoloration left behind to resolve. If the child still has an active rash which has not been diagnosed she should see a dermatologist. A skin biopsy may be necessary.
Peeling hands and feet do not indicate a kidney problem. They may be seen with excessive sweating or playing in water, atopic (allergic) dermatitis, fungus infections, and in association with a strep infection. I have no reason to think this new rash is related to the previous rash.
Sincerely,
Dr. Warren
It would so much be appreciated.
My son is an A first grader. No problems at home.
-MS
Dear MS: Your son is not the only 6 year old to experience pain in his belly button. In fact, most small intestinal pain is referred to that area. In addition, young children report most abdominal pain as being centered in the belly button leaving all the possible causes of abdominal pain as potential diagnoses. The gastroenterologist is the right specialist to see at this point, although, given his history of intussusception and prior surgeries, his pediatric surgeon should be involved in the evaluation.
Sincerely,
Dr. Warren
-(unsigned)
Dear 17 year old male: There is no danger or long term side effects to masturbating. Neither is there a specific amount that is safe, so since you're 17 and old enough to use common sense, just consider whether or not the amount of time you spend masturbating is interfering with other important activities. In addition, ask yourself if you are becoming sore from excess handling. I, for one, can't imagine anyone spending enough time masturbating to become sore or miss out on other activities, but even though masturbation is a perfectly safe outlet, I'm reluctant to sound like I endorse spending all your time doing it.
Sincerely,
Dr. Warren
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