9 February 1997
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 physician who knows you and cares about you.
Dr. Warren
-LKP
Dear LKP: Molluscum contagiosum is a kind of wart. As with other warts, it is caused by a virus. Mollusca look different from other warts. They look like small shiny, waxy or pearly bumps. As with other warts, their removal can be painful. In addition, since the warts are caused by a virus, even after removal the warts may come back. In many instances the best thing to do may be nothing since the warts often resolve spontaneously.
On the other hand, removal might be considered for several reasons: The mollusca may be a cosmetic issue for some children. When left in place there may sometimes be some considerable local spread. If the children pick at them there is a risk of infection.
In your child's situation it sounds like the mollusca are scattered and, even though new ones keep appearing, the old ones dry up on their own. Therefore, it may be best to just leave your child's mollusca alone. In order to make a sound choice you might wish to consult a Pediatric Dermatologist for your therapeutic options.
Sincerely,
Dr. Warren
-LT
Dear LT: When a child has several illnesses in a short time and one of them is a potentially serious illness like pneumonia, you might think that both illnesses are related; however, since your 4 year old was fully recovered from his pneumonia and off antibiotics for almost 3 weeks when he became sick again, and so many childhood infectious diseases cause fever, this may simply be a new illness.Fever is a sign that your son's body is fighting an infection. The fever will actually help him fight the infection. Fever in the range below 106 degrees F is not dangerous and does not require a major effort to bring it down. Of course your should treat his fever with Tylenol or Ibuprofen (Motrin or Advil) to make him more comfortable. He should be dressed lightly and drink plenty of fluids.
The height of the fever is not really a good guide to how sick your child is, however, since serious infections like meningitis and pneumonia usually cause high fever, children with high fever should be checked by a doctor. His other symptoms and how sick he is acting are much more important than the fever to tell you how concerned you should be. While there is some increased risk of pneumonia again after having pneumonia last month, you have to make the same decisions you usually make when he is sick. If he has any worrisome symptoms or is looking or acting very sick, then he needs to see his pediatrician.
Sincerely,
Dr. Warren
-JS
Dear JS: It is not normal to turn blue around the mouth. Of course the most serious possibility is heart disease. If she had a thorough cardiac evaluation and that was normal you probably don't need to worry. She may have some degree of breath holding when she laughs or cries and that could account for turning blue. I am somewhat puzzled as to why she would turn blue when she lies down. That might be seen with significant upper airway obstruction as seen with large tonsils and adenoids, but that would usually cause snoring. To help decide whether or not your daughter requires further evaluation perhaps your pediatrician could arrange for her to have her oxygen saturation monitored with a pulse oximeter. If her readings are low, she should be further evaluated. If she has normal readings even when her lips look blue, then you probably don't need to be concerned.
Sincerely,
Dr. Warren
-DL
Dear DL: It is possible to have some spotting (a small amount of bleeding) during pregnancy, and on rare occasions, some women have spotting monthly, so, in answer to your question, it is possible for your girlfriend to be pregnant. On the other hand, any bleeding during a pregnancy could be serious. In early pregnancy it could be a sign of a tubal or ectopic pregnancy which is dangerous. Therefore, if your girlfriend believes she is pregnant she is foolish if she doesn't get appropriate medical care.Before you decide how scared you should be the first thing you should ask yourself is, is there any chance that your girlfriend could be pregnant? Did you use any birth control? Just what is your relationship with this girl that you don't know if you can trust her to tell you the truth about whether or not she is pregnant? And why is she unwilling to have a pregnancy test? Regardless of whether or not your girlfriend is pregnant it sounds like you have some serious communication and trust issues to deal with in your relationship.
You don't state your age, but I sense from your letter that you are not an adult. You and your girlfriend should not try to deal with this alone. Teens who deal with problems they cannot handle often commit acts of desperation that compound their problems. If you cannot go to your parents you should seek the advice of a school counselor or another adult you can trust. If you cannot do that, both you and your girlfriend should visit your local Planned Parenthood. They take care of all phases of family planning including prenatal care for the mother to be. They can also provide you with appropriate counseling to help you understand and deal with all your options.
Sincerely,
Dr. Warren
-T. Q., D.D.S.
Dear Dr. Q: In answering your question I feel like I might be missing some important information. You say he has been treated for VARIOUS parasites including pinworms. Pinworms primarily cause rectal itching and don't cause your son's symptoms, and they are very common. But if your son has had multiple other parasites, the first question is, "why?" The second question is, "Does he have a parasite that was missed?" And the third question is, "Was he cured?" It is certainly possible to have relapses with Giardia which may cause these symptoms.Lactose intolerance is certainly a good idea. If it wasn't fully ruled out by testing his poor response to eliminating lactose from his diet may have resulted from not finding the hidden lactose in his diet. If he is exquisitely sensitive to lactose you really have to read all labels to be sure he has a lactose free diet and may need to consult a nutritionist. Other sugars besides lactose may cause malabsorption with gas, bloating, and/or diarrhea. Excess fructose and sorbitol in fruit juice may cause symptoms. Sorbitol is also the culprit in children who chew too much sugar-free gum (Nutrasweet does not cause these symptoms).
Air swallowing may cause gas and bloating. A child would have to swallow an awful lot of air to cause such constant symptoms, but if he eats fast and gulps his food and drink air swallowing may play a role.
Since you have an appointment with a gastroenterologist by all means keep the appointment. And, for my own education, let me know what they find.
Sincerely,
Dr. Warren
Thank you so much for your time and advice.
Sincerely,
-E
Dear E: You don't have to worry even a little about your son ingesting some stool. The reason that stool contamination of food or water is considered a health hazard is that it can spread disease like salmonella and parasites. But your son couldn't possibly catch anything from his own stool. In order for his stool to have any pathogenic organisms in it, he would already have to have the disease.Sincerely,
Dr. Warren
1. At what age would you advise to let the baby sleep face down? Right now
she's making the baby sleep face up.
2. Does drinking milk stop the production of "her" milk?
3. Can she drink coffee while breastfeeding the baby? She didn't drink her
usual morning cup of coffee today, and the baby slept for three consecutive
hours, something amazing, according to her. She's going to try it again
tomorrow to see if it was the coffee indeed that was affecting the baby's
sleep or if it was just pure coincidence.
4. What foods or teas can increase the production of the mother's milk, if
any?
I want to thank you in advance for answering these questions. Your answers
are going to be of great help!!
Thanks!!
-LH
Dear LH: The answers to your questions are as follows:1. Babies should be put into their cribs on their backs because several studies have shown an increased risk of SIDS (Sudden Infant Death) associated with sleeping on the stomach. When a baby can turn over himself, if he wants to be on his stomach, he will turn over.
2. If a nursing mother is drinking cow's milk it will not affect her own milk production; however, some nursing babies become colicky if their mothers drink a lot of cow's milk.If the baby drinks any other milk besides his mother's milk, the decreased stimulation to the breasts will result in less milk production by the mother.
3. Caffeine crosses into breast milk and can act as a stimulant to the nursing baby. If the baby sleeps better when mom avoids coffee, mom should switch to decaffeinated coffee or stop drinking coffee.
4. Drinking plenty of fluids, eating a balanced diet, and getting adequate rest will help milk production. I am not aware of any foods which specifically increase milk production, but if there is something that would, the good people at La Leche League would know. They are an excellent source of information about nursing and should be listed in your phone book.
Sincerely,
Dr. Warren
We have had her to her doctor twice over the head-aches. The last time he had a Glucose tolerance test run on her(ok). He prescribed Elavil for her and said maybe she was having Migrains. I thought the first time or two that she was pulling one of my childhood tricks, and didnt want to go to school, but that is not the case. Would appreciate your thoughts on this.
-DH
Dear : Headaches are actually a fairly common complaint in childhood. The most common headaches are muscle tension headaches (commonly known as tension headaches). While tension or stress may play a role in causing headaches, the term "muscle tension headache" refers to the fact that the pain is caused by contraction of the muscles in the scalp and neck. Imagine squeezing a rock tightly in your hand and, when the muscles in your hand begin to cramp, not letting go. Now you can understand how much pain a muscle tension headache can cause. these headaches may be caused by fatigue or physical activity.Migraine headaches occur in childhood as well. Migraines usually occur on one side of the head. The pain is generally pounding or throbbing. Nausea and vomiting may occur with migraines. Most migraine sufferers go to sleep when they have headaches and may awaken feeling better. There is often a family history of migraine. In those who are sensitive to certain foods migraines may be provoked by chocolate, hard cheese like cheddar, or red wine. Migraines are often associated with or preceded by vision changes such as flashing spots of light.
Sudden onset of severe headache may be a serious event. If associated with fever, vomiting, and stiff neck it may be a sign of meningitis. Headaches associated with neurological symptoms such as seizure, altered state of consciousness, slurred speech, double vision, loss of balance, personality change, loss of memory, or vomiting (especially early morning vomiting) may be seen with bleeding in the head or brain tumors so thorough neurological evaluation including CT scan or MRI may be required.
Headaches may be seen with anemia, so a blood count should be checked. Excess Vitamin A may cause swelling of the brain and therefore headache. Caffeine withdrawal in addicted people causes headaches. Caffeine can be found in many soft drinks as well as tea and coffee. Infections in sinuses, teeth, ears, and throats may cause headaches. The cause of the headache can best be determined by having a thorough examination including blood pressure. The more information the doctor is given about the headache and any other associated symptoms the better the chance of an accurate diagnosis.
If a child has mild headaches, which I would define as headaches that don't interfere with activity and respond to treatment with Tylenol, there is no cause for concern. More severe headaches my respond to Ibuprofen (Children's Advil or Motrin) in a dose of 1 teaspoon per 22 lbs. every 4-6 hours with a maximum dose of 4 teaspoons per dose and a maximum of 4 doses per day. Sedative medications such as phenobarbital and Elavil may be used when other pain medications alone do not provide adequate relief. There are a variety of medications which are useful in treating migraines, some as preventives, and others for pain relief, but they are reserved for situations where the diagnosis has been established and require careful follow up and monitoring.
Sincerely,
Dr. Warren
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