7 July 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
Please e-mail me as soon as you have a chance.
Thank you.
Waiting to here from you.
-Kelly
Dear Kelly: There is good reason to be concerned about your daughter's weight. It is an even greater cause for concern if her current growth pattern shows that she is becoming progressively more overweight. Overweight kids suffer socially as well as physically. Although it remains unproven, some believe that the fat cells which develop in childhood contribute to the difficulty overweight adults have in controlling their weight. Whether or not you believe the "fat cell" theory has any merit, there is no question that obese children have a high risk of becoming obese adults. The reasons for this are complex. Eating habits, exercise habits, and activity level during childhood often influence those habits in adulthood. Emotional issues about food, weight, and self esteem which develop in childhood exert an influence in later life. And most important, the genetic and other factors which are part of the child which contributed to his becoming overweight will not magically disappear with age. It does not become easier for a child to control his weight when he is older.
Even though it is tough for parents to deny young kids the treats they want or to not respond with food to the plaintiff cry, "I'm hungry!" by the time an obese child reaches school age, he will be at a significant social disadvantage. He will see that he is different. Other children will likely taunt him about his being overweight. He will probably have difficulty keeping up with the other kids in their games. Even adults will consider every bite of food they see him put in his mouth as over indulgence. The school age child is not better suited to handle the emotional issues associated with weight control than the preschooler. Abstract reasoning with the ability to make sound decisions such as whether or not to diet, does not develop until adolescence, and by then there are many other emotional issues. If good eating habits have not been established before adolescence, many teens, even those who want to lose weight, will not want their parents advice or involvement. The bottom line is that unless we are willing to let a child suffer through his entire childhood with obesity, we have to intervene. And so, it would seem, better sooner than later.
Why am I telling you this when you are obviously already on my wavelength? Because you could probably use some ongoing input from your daughter's pediatrician, so you will need to broach the subject with him again. I don't know for sure why your daughter is overweight since she is following a sensible diet. Since she is growing well, it is unlikely that any gland disorder is contributing to her problem; however, as time goes by her doctor may need to reevaluate the possibility of any disorder which could contribute to her problem. You need a doctor involved in reviewing her diet and activity level to determine if her excess weight gain requires further evaluation and intervention.
Even though I don't know why your daughter is overweight, the basic principal remains the same, even when a child has medical or genetic causes contributing to obesity. To gain weight above and beyond weight gained from growing, a child must consume more calories than he burns. To reverse that and control weight, a child must consume fewer calories and burn more calories by increasing activity. Even though you've switched your child to a healthy, low fat diet, she may still be consuming too many calories. When it comes to weight gain, the body doesn't distinguish between good for you calories and bad for you calories. If a person consumes an excess of healthy, low fat calories, he will still gain too much weight. His choice is then to cut his portion sizes and the frequency of meals or snacks, and/or to increase his activity level. For more information on this subject, please read my article, Childhood Obesity.
Sincerely,
Dr. Warren
What steps can a parent take to lower the risks of SIDS?
-C
Dear C: SIDS (sudden infant death syndrome) is a pediatric problem because it only affects infants. It is a rare syndrome in which apparently healthy infants are found dead in their cribs. It is also known as "crib death." It affects children under 2 years of age. The cause is unknown.
Parents can decrease the risk of SIDS by making sure they put their infants to sleep on their backs. Studies have proven that the risk of SIDS is increased by sleeping on the belly. Once infants can roll over, hopefully they will have developed a preference for sleeping on their backs; however some infants will roll over, so it is also important to avoid soft mattresses, mattress covers, or other plush coverings for the infant to sleep on.
Sincerely,
Dr. Warren
-Ms. T
Dear Ms. T: It is always difficult for me to comment on rashes or lesions which I have not seen. If the sores are clustered, they could be fever blisters (cold sores) which are caused by Herpes simplex virus. If so they probably just need time to heal. If the sores are scattered, they may be impetigo, a superficial skin infection caused by staphylococcus or streptococcus. While it is not serious, it can cause complications and is unlikely to resolve without treatment. Since I cannot make an accurate diagnosis over the web and your son may need treatment, the best choice would be to see his pediatrician.
Sincerely,
Dr. Warren
-CS
Dear CS: Any person who gets migraines will very likely have more severe headaches with any illness; however, few acute infectious illnesses cause symptoms for 17 days. That is also an extraordinarily long time for an unremitting headache, even in a person who has migraines. You did not say how long ago your son had the imaging studies (MRI). If it was not part of the evaluation for this current headache, it should be repeated.
A bacterial meningitis would have made your son seriously ill well before this, so time alone has ruled out that possibility, but a spinal tap may be necessary to rule out other infections such as Lyme disease and tuberculous meningitis. If there is a clinical suspicion of Lyme blood tests might help. A skin test (PPD) could be the initial screen for tuberculosis. The doctor's physical examination should help determine if there is any reason to consider doing a spinal tap. Chronic sinus infection might also cause headache.
Recurrent headaches may also be caused by illness unrelated to the head. Anemia may cause headaches, although I have never heard of such a severe or persistent headache from anemia. In any event, your son should have a thorough general examination as well as an evaluation specific for headaches.
Anyone else at home having headaches? Consider a toxic exposure such as carbon monoxide.
Please do let me know what happens.
Sincerely,
Dr. Warren
-SD
Dear SD: I cannot quote you any statistics on the frequency of labial adhesions, but it is not rare. I see a few girls each year with the problem. Just as the premarin cream, which is an estrogen cream, helps to open the adhesions, some girls may experience resolution of the problem with puberty. If the adhesions are thick, obstruct urine flow, or cause pooling of urine in the vagina, surgical correction may be necessary. This would be done by a pediatric urologist.
Since premarin is a hormone and may be irritating to the skin, prolonged use is not advisable in little girls. Absorption of the hormone might even cause breast engorgement. I generally recommend a 2 week course followed by at least a 2 week break before trying another course of treatment.
Sincerely,
Dr. Warren
-Mr. L
Dear Mr. L: I can't think of any medical reason why hypothyroidism would affect a pregnancy test. Nonetheless, the kit should come with a complete set of documentation which includes not only instructions but an explanation of the limitations of the test. Since not all tests are the same your best bet would be to check the documentation which came with yours.
Sincerely,
Dr. Warren
The baby of a colleage of mine is 4 months old. It started to bleed through the right nipple in larger quantities. This can stop for one or two days but starts to bleed again.
Furthermore the baby has red exanthemes who turn brown and dissappear. But they always return.
The boy seem to be OK (no pain and no fever). No vaccination was made because the doctors dont know what he has.
University hospitals have taken blood probes - no allergies or unusual results. They can't help them here in Germany and have no clue was he has.
Therefore my colleague asked me whether I could ask a doctor in the USA whether you have heard of such a case and can help my colleague maybe.
Thanks for you efforts in advance.
-M
Dear M: It is most difficult to come up with a differential diagnosis with scant information about a patient I haven't seen. I did a literature search for bleeding from the nipple and came up with nothing. If the bleeding is coming from inside the breast and is not a result of local irritation of the skin, some imaging study (ultrasound, CT scan, MRI) must be considered to locate the source of the bleeding. Normal breast tissue does not bleed even if it is still engorged from exposure to maternal hormones. You would be looking for infection (abscess), tumor, or vascular anomaly as a source of blood.
Is the rash related? Many babies get rashes. If the doctors feel that this rash is not a typical childhood rash like an eczema or seborrhea, perhaps a biopsy of the rash may give a clue to the diagnosis. By the way, although I have never seen it, I understand that Histiocytosis X can look like seborrhea.
You must also determine if the baby has any clotting abnormality which would contribute to continued bleeding.
Unfortunately, I have no other ideas.
Sincerely,
Dr. Warren
-Baby's Dad
Dear Baby's Dad: The soft spot (fontanel) usually closed between 10 and 16 months of age. The skull consists of multiple bones. The fontanel is a place where 4 major bones of the skull come together. In an adult, all the bones have fused to make a solid skull. The newborns skull bones are not fused and can even overlap if necessary to allow the baby to pass through the birth canal. Even after birth the skull bones don't fuse immediately. This allows for rapid growth of the head to accommodate rapid growth of the brain. Premature fusion of the skull bones, known as craniosynostosis, may result in a misshapen head and, if all the bones are fused, not allow enough room for normal brain growth, which could cause mental retardation. Premature closure of the fontanel may be a sign of premature fusion of the skull bones; however, if the skull bones are not prematurely fused, the early closure of the fontanel will not do any harm. If the baby has craniosynostosis, the baby will require surgery to open the sutures (the lines where the skull bones come together).
Sincerely,
Dr. Warren
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