25 February 2008

1. Dextrostat
2. Abnormal "PKU" Test
3. Can't Diagnose Rash
4. Infant Likes to Stand
5. Tics and Language Delay
6. Infant Sleeping and Feeding Patterns
7. VUR and Future Problems
8. Diseases from Pools
9. Disclaimer

• Read Questions & Answers in Another Column

Dextrostat

-AW

Dear AW: Dextrostat is an amphetamine which is used for its stimulant properties to treat attention deficit disorder. Stimulants help children with attention deficit disorder by increasing their attention span making it possible for them to concentrate on the task at hand.

Because Dextrostat is a stimulant it can cause rapid heart rate, increased blood pressure, insomnia, and loss of appetite. Most children tolerate the medication very well. From a practical standpoint, the major side effect which must be monitored is its effect on appetite. When children don't eat adequately they don't grow properly. Therefore, a child who is on a stimulant of any sort must have his height and weight monitored regularly.

Amphetamines are also street drugs which can be abused; however, when taken as prescribed addiction and abuse is not a problem. Some studies have shown that children who are treated for attention deficit disorder are less likely to abuse drugs than those whose attention deficit disorder is untreated.

If the medication is having the desired effect, namely, that your son is more attentive, and has not had any undesirable side effects then he should continue to take it as prescribed. When possible, it is desirable for children to be off the medication when not in school. The medication is safe for long term use as long as it is not interfering with growth.

Sincerely,
Dr. Warren

Note to Readers:Many specialists who treat ADHD with the newer, long acting medications recommend that children stay on their medications year round including holidays and weekends. This can help with social issues, behavioral issues, and even success in sports.

Thank you!

-D and C

Dear D and C: While the newborn screening is stilled called the PKU since that was the first disease for which newborn screening was instituted, most states have newborn screenings which measure multiple items. Aside from screening for rare metabolic diseases, newborn screenings also check for hemoglobinopathies (like sickle cell disease) and hypothyroidism. Without knowing which test was abnormal on your infant's screening, it's hard for me to comment, but we often get requests for repeat screening for hypothyroidism. Most of the repeat screenings come out normal. The thing to keep in mind is, that if your child actually has a disease picked up on a newborn screening, the reason these tests are included on the newborn screening is that by making an early diagnosis and starting treatment early before any damage is done, these children grow up healthy. Of course you'd rather everything be fine, but the worst case scenario is that your baby might need to be on medication or have a special diet. So don't be alarmed. I can't promise everything will be normal, but it will be okay.

Sincerely,
Dr. Warren

-Tamika

Dear Tamika: Unfortunately, it's almost impossible for me to guess what a rash is without seeing it unless the rash has some unusual unique feature whose description makes it clear to me. I might guess, since the rash is covering your son's entire body, that it could be a rash from a virus, a reaction to a new detergent or fabric softener, a reaction to a sunscreen or body lotion. If your pediatrician is stumped on this one, he should send you to a dermatologist.

Sincerely,
Dr. Warren

Sincerely,
-New Mother

Dear New Mother: It can not do any harm to let your 3½ month old to stand with your support. Obviously she cannot stand without your support. She is not bearing her entire weight, and when she is tired she will no longer keep her legs extended or bear weight on them. Infants cannot become bowlegged from standing, nor will it harm their hips.

Sincerely,
Dr. Warren

She is aged 5 and a half, and lives 11 months out of 12 with her mother and grandmother; she sees her father only once a year (parents are divorced). Her grandmother is omnipresent to her, and usually let her do most of what she wants. Her mother is more strict, but is still also quite tolerant with her. Both women continue to treat her like a baby (she drinks more than 1 liter of milk every day out of a baby's feeding bottle, still uses a potty...). She has tics as sniffing, or waving handkerchiefs with the same movement, but not all the time nevertheless. Also quite regularly, especially when in the streets, she shouts very loudly and repeatedly "mama" or other short words. She is usually very active, runs constantly all around and seems to have balance problems when she is running. She has a very restricted vocabulary, always saying the same words and phrases ("Mummy were are we going, what is this, why is this" etc.). She doesn't manage at all to understand what is happening around her or where she is. She lives exclusively in the present and behaves like a 2 years old baby. She goes to nursery school, but doesn't play with other children. In fact she is not interested neither by them, nor by the outside world. When her mother is annoyed with her, she sulks angrily with a kind of eye tic that can last a long time. Still she seems intelligent, remembers peoples and situations.

Her mother thinks her attitude is mostly due to the fact that her grandmother is too tolerant with her and that therefore she is spoiled. She went with her to hospital where she was examined and had EEG and a CT, whose results are still unknown. A nurse told to her that it could be epilepsy, but without any certainty, and anyway she never has any crisis.

So I was thinking about Tourette disease, but I wonder if it couldn't be something else like hereditary brain damage, or another illness as she has tics but not constantly. If you could help me to know what this could be I would very much appreciate. Medicine in Bosnia is disastrous, and my friend fears that doctors will not find exactly what is her daughter's problem. I have suggested her to come in France to have tests here if necessary, and will anyway have EEG and CT checked by French doctors.

Thank you for your help

-J

Dear J: From what you have told me, I doubt that you are describing Tourette's. While it is possible for a child with language delay to have Tourette's, a language disorder is not part of Tourette's. In addition, while children with Tourette's have a higher incidence of attention problems than others and may have social problems due to their symptoms, they are not uninterested in the outside world. Their gross motor tics are twitches rather than repetitive motions such as waving a handkerchief. In fact, the child's pervasive ignoring of the world around her associated with such repetitive movements suggests Pervasive Developmental Disorder, also known as childhood autism. Of course, I cannot be sure of the diagnosis on the basis of a description in an e-mail.

Could the child's bizarre upbringing account for her strange behavior? I'm sure it doesn't help. But more than likely, the mother and grandmother do not respond to the child as a normal child because she is not normal.

The diagnosis of PDD is the easy part. The difficult part is getting these children to live up to their potential, which requires special behavioral techniques and educational techniques. Since the child has had an EEG and CT scan, I assume that some evaluation is underway by a pediatric neurologist. Once those results are available, it is time to discuss the diagnostic possibilities and the treatment options. Even without a clear diagnosis this child needs intervention aimed at dealing with socialization and language development. If Mom has the ability to travel, there may be much more to offer the child in France than in Sarajevo; however, if the child and her family will ultimately end up living in Sarajevo, they need to explore what services are available for her there.

Sincerely,
Dr. Warren

Thanks.

-FMC

Dear FMC: Some newborns may sleep as much as 22 hours a day, so when those babies feed well, we are not concerned about the amount they sleep. If a baby's pattern has been to spend more time awake and the baby suddenly starts sleeping a lot, it could be an important sign of illness; however, I don't think that's the case with your baby. You say for "the past few days [your son] has been doing nothing but sleep." That would be very worrisome in a 9 week old; however, you imply that he is awake from 7 AM to 11 AM, but doesn't want to eat. Still, his consumption is up to 29 ounces per day, which is good. You also say, "When he awakes from his sleeps he appears alert & happy" which is a sign that he really is okay.

I think his previous feeding pattern was not a very good one. No baby should be feeding every 30 to 90 minutes. Although I'm a believer in demand feeding, it takes the stomach approximately 3-4 hours to digest food and empty into the small intestine. That's why most babies are ready for another feeding in the 3 to 4 hour range. When infants take small amounts frequently, the continuous drip of small amounts of food into the stomach prevents it from emptying completely, so they don't get hungry enough to take a full feeding, and so don't develop a normal feeding pattern. I think, with maturity, fortunately your son has developed a normal feeding pattern on his own. As long as he feeds well, gains well, and has periods of time when he is awake, alert, and happy, I think you are seeing an improved feeding pattern rather than a problem.

Sincerely,
Dr. Warren

Thank you for your time.

-KW

Dear KW: The risk associated with grade III urinary reflux is infection in the kidney. Of course, if the kidneys are damaged, that can lead to significant future health problems. Generally management consists of prophylactic antibiotics to prevent urinary tract infection, periodic cultures to check for infection, and a repeat VCU to check for resolution of the reflux. If the reflux does not resolve, it will be treated surgically.

Assuming the child is otherwise healthy and has proper care and follow up of her reflux, it should not have any impact on her ability to have children or any other long term complications.

Sincerely,
Dr. Warren

-CD

Dear CD: Neither AIDS nor herpes spread through swimming pools; however, other diseases can, so you should use the appropriate method for cleaning your pool and disinfecting the water based on the size of the pool. Small kiddie pools should be emptied regularly. Larger pools should be chlorinated to help prevent the spread of disease.

Sincerely,
Dr. Warren

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