9 March 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
-AJM
Dear AJM: Lymph nodes are part of the body's defense system against disease. When the body is fighting an infection lymph nodes enlarge as they get ready for battle. Since children have many colds and sore throats it is very common for them to have swollen lymph nodes (also called swollen glands) in the neck. A child may develop a swollen node in the groin from a rash on the foot or an ingrown toenail. Virus infections may cause swollen glands all over the body. Once a lymph node swells it will shrink again after the illness is over, but it will not disappear completely and it will swell again with the next virus infection. It is not uncommon for inflammatory lymph nodes to be anywhere from 1-3 cm. in size. As long as your doctor has checked her and told you everything is okay, there is no need to worry.
Sincerely,
Dr. Warren
That was this this Saturday, and was the second time she has done this so we are critically alarmed, and hence the reason for seeing our pediatrician., We are scared to death and seeking answers as frantically as possible, the Dr. advised an EKG and a brain scan, Lauren basically had another "episode" as the Dr. examined her so we're not exactly happy about racing her to another traumatic event like a hospital.
Can you steer us to any literature or online help so we can absorb as much data on these symptoms as possible.
L. is 2 years old caucasian normal in every aspect weight/ height etc.... no medical history whatsoever
-Scared Parents
Dear Scared Parents: It is hard for me to be sure from your description whether or not your daughter has breath holding spells, but let me explain them to you and you can decide if the description fits.Breath holding spells occur when a child is upset and crying hard. Seizures may sometimes be provoked by fever, illness, or stress, but basically occur sporadically with no relation to crying. The typical breath holding spell starts with a child crying so hard that he holds his breath. The child in that situation is holding his mouth wide open as if screaming but because he has reached the point of holding his breath, no sound comes out. If he continues to hold his breath, the child turns blue around the mouth. Eventually the child either catches his breath or passes out. The eyes may roll back into the head and the child go limp if he passes out but then he can no longer hold his breath so he begins to breathe easily. After that the child usually comes around very quickly and may even resume crying. A child having a seizure may sometimes turn blue if his breathing is obstructed, but most seizures occur without cyanosis (turning blue). The seizure may begin with a vocal noise but has nothing to do with crying. The child having a seizure will not be seen in the typical open mouthed can't get the cry out posture of the breath holder. A seizure will generally involve stiffening of arms and legs followed by twitching of the extremities or some other rhythmic type movement. After that the child usually becomes limp and unresponsive usually for several minutes. During a seizure a child may salivate, urinate, and/or defecate.
Perhaps if you review the exact description of what happened with your pediatrician you can decide more easily whether additional testing is necessary. If not, you might wish to consult a Pediatric Neurologist before you commit to additional testing.
Sincerely,
Dr. Warren
-S
Dear S: The correct dose for Erythromycin is 30-50 mg./kg./day. At 80 lbs. your son weighs 36 kg. which means his daily dose of Erythromycin should be 1080-1800 mg./day, with the maximum dose being 2000 mg./day. In practice, we treat most children his size with a dose between 800 and 1200 mg. Your son is getting 999 mg. so his dose is correct.
Some people just can't tolerate Erythromycin. If that is the case there are alternatives. First, in order to avoid prescribing unnecessary antibiotics when your son has a red throat your pediatrician should do a throat culture or a rapid strep test to see if it is strep throat. If your son has a virus sore throat instead of strep, antibiotics will not help and it is better not to prescribe them. If your son has strep the treatment of choice is Penicillin. Erythromycin should only be used as an alternative in Penicillin allergic patients. If Penicillin cannot be used, your physician has many other options depending on your son's allergy history.
Sincerely,
Dr. Warren
-B
Dear B: It is possible that your son hurt his knee, but if he was ill at the same time he had the knee pain it is more likely that the knee pain is related to being sick. Knee pain in children is often pain in the hip which is referred to the knee. Toxic Synovitis of the hip is one cause of knee/hip pain in children. Although the children may complain about their knee, it is movement of the hip that causes them pain. Toxic Synovitis is often seen after upper respiratory viruses. In spite of how scary the name is, it is not serious and children generally recover completely. If a child is acutely ill with something that looks like Toxic Synovitis it is very important to be sure that he doesn't have an infection in the joint space. Also, if he has persisting pain he needs to be evaluated to be sure that he doesn't have Perthes disease since early treatment will usually result in a good outcome.If your son has strep throat rheumatic fever is an important cause of joint pain. Rheumatic fever is a late complication of strep and doesn't generally occur during the sore throat. It does cause fever. The involved joint is red, swollen, and exquisitely tender to touch.
Finally, we always have to consider arthritis such as Juvenile Rheumatoid Arthritis and Lyme disease in children who have joint symptoms. If you live in an area where Lyme is prevalent it may be a consideration; however, if you are experiencing winter weather exposure to the tick that carries Lyme disease would be unlikely this time of year. Both JRA and Lyme may cause a lot of long term symptoms such as recurrent fevers and aches before a joint or two swells.
For further evaluation of acute symptoms if joint infection, Perthes, or Toxic Synovitis are the main considerations you should consult an orthopedist. For chronic or recurrent joint symptoms where JRA or Lyme might be a consideration a Rheumatologist can help. If your son's pains have not resolved you should have your pediatrician reevaluate him and make an appropriate referral depending on his findings.
Sincerely,
Dr. Warren
P.S. I love your web-site. What a neat idea!
-KB
Dear Dr. Warren: My daughter was born 8 months ago and weighed in at 7# 14 oz. From birth, she was not interested in eating whatsoever and lost weigh instead of gaining. After struggling with different formulas, etc. we finally achieved a 4-6 oz. intake every 4 hours. Presently, at 8 mos. of age she weighs about 13 pounds. Developmentally, she is right on queue. I still worry if she is taking in enough to grow, she still seems so litte. Presently, she eats cereal 2 times a day (1/2 cup), and fruits and veggies 2 times a day (for a total of 2 jars of baby food), and at best 16 ounces of formula -including what is used to mix up her cereal. Am I being too nervous about this? My first child weight 9# and was 13# by his 6 week checkup. Help.-KB
Dear KB: One must be careful about comparing two children even when they are siblings. If the genetic makeup of your family includes both large and small people it is possible for the growth patterns of two siblings to be very different and yet normal. 13 lbs. is approximately at the 50th percentile for a 4 month old. So you can see that while your second child is small by comparison, your first was large. 13 lbs. for an 8 month old is just below the 5th percentile. While this is just below the normal range you need to review all of her growth data with her pediatrician. If she has been growing just below the 5th percentile all along she may simply be small. If, on the other hand her rate of weight gain only recently decreased so that she has fallen off her growth curve, you need to find out why. Your first step, then, is to consult your pediatrician and see if he thinks her growth has been satisfactory.If your child has a persistent eye turn at 8 months of age that would be a cause for concern. On the other hand, if her eye only occasionally wanders there is less concern. Parents often think their child has an eye turn when, in fact, they may be mistaken about what a child is actually looking at. The best way to see if her eyes are coordinated is to try to get your daughter to look at a flashlight. If the reflection of light is in the center of both pupils when she looks at the light then her eyes are working together properly.
Sincerely,
Dr. Warren
-TR
Dear TR: The normal intake of formula for babies is quite variable. 4 ounces for 5 feedings per day (total = 600 ml) may be normal. I've seen skinny babies consume 6-8 ounces at a feeding and large babies consuming as little as 4 ounces. The most crucial thing to know is whether or not your baby is growing and gaining weight normally. If you suspect a feeding problem you should review your baby's growth with your pediatrician.
Some factors which may influence a baby's feeding:
Sincerely,
Dr. Warren
-JL
Dear JL: All newborns develop some engorgement of the breasts because of exposure to female hormones when they were in the womb. Sometimes the breast enlargement is quite significant. It may increase for a few weeks and does not have to be symmetrical. The breast swelling may be only on one side. This is normal and is not a cyst or tumor.The only time you need to worry about infant breast engorgement is when the swelling is red and tender. Generally the baby would be irritable and running fever. This is a sign of an infection called mastitis and requires medical attention.
Sincerely,
Dr. Warren
-P
Dear P: The purpose of using a vaporizer or a humidifier for a child who has a cold is to keep the mucus moist and to keep the membranes moist. This makes it easier for the child to clear the secretions. Vaporizers and humidifiers made for the bedside produce water droplets which are too large to get into the lungs. They only moisturize the upper airways.Ultrasonic Humidifiers are room humidifiers. They are NOT meant to be placed at the bedside. The water droplets they produce are small enough to get into the lungs, and, as you correctly realized, that is not desirable.
Sincerely,
Dr. Warren
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