16 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
-L & A A
Dear Mr. & Mrs. A: Most infants who have a slight flattening of one side of the head generally have that as a result of positioning. This has increased as a result of the push to put infants to sleep on their backs because it lowers the incidence of SIDS. If a baby spends a lot of time laying on one spot in his head it will flatten. When we notice this in early infancy we encourage changing the baby's sleep position so that he will turn his head the other way. If the infant has a preference for keeping his head turned one way or an obviously tight neck muscle contributing to the problem we recommend routine turning of the head and stretching of the neck muscle with each diaper change. While this condition may result in some asymmetry of the head and even the face surgical intervention is rarely warranted.
Craniosynostosis is a condition where there is premature fusion of one or more growth lines of the head. This will also result in an abnormal shape to the head, but it is a much more serious condition than what I previously described. The issue with craniosynostosis is more than cosmetic. Since the head cannot grow properly with craniosynostosis it puts pressure on the growing brain. The earlier craniosynostosis is diagnosed and repaired, the better.
The staff of the cranio-facial specialist may have assumed that your baby has a serious condition when you made the appointment, but even if they had some basis for their assumption their comments were inappropriate. The specialist may want a CT scan of the baby's head before he gives you any recommendations, but once he has examined your child and completed all tests he should be able to tell you the following:
It is certainly possible that your child fits into the first category I described and that the specialist will provide you with the reassurance that you need. But in the event that the specialist recommends treatment make sure you explore all six of the above issues. If you don't feel satisfied that you understand all six so that you can play an active role in deciding your son's treatment, seek another opinion.
Sincerely,
Dr. Warren
-N
Dear N: After a seizure there is a variable period of time when a person remains unresponsive. This period is known as post-ictal phase. The post-ictal phase generally doesn't last hours and once the patient has recovered he is awake. Therefore, sleeping a good part of the day and eating a meal during the lethargy is not consistent with a seizure. If your child did have a seizure during sleep, it is possible that you would have difficulty waking him if you tried right after the seizure, but the rest of what happened afterward doesn't fit.It is certainly possible for a child who is ill or just coming down with something to act the way you described. It isn't necessary to run a fever to show the other signs of illness. The doctor's findings of a sore throat could have explained your child's symptoms; however, a child with all the symptoms you described deserves a thorough examination. If this happens again try to get your son seen where he will have a complete evaluation. If you must go to the emergency room, make arrangements for him to be seen by your pediatrician afterward.
I have twice had patients who acted in the manner you described. They were both skinny kids with poor appetites. When they became ill, they didn't eat and they became hypoglycemic (low blood sugar). The symptoms of being cold, clammy, and lethargic may be seen with hypoglycemia. Hypoglycemia is more likely to occur first thing in the morning after a child hasn't eaten all night, especially if the child missed meals or ate poorly the day before. Your son's willingness to eat a meal even in his stupor is a bit inconsistent with not feeling well, but it may be a reasonable response to hypoglycemia. If your son should have these symptoms again he should have his blood sugar checked while he is symptomatic. If he is hypoglycemic he can be given intravenous glucose and you will see a dramatic improvement. If his blood sugar is tested when he has no symptoms it will probably be normal and that won't tell you anything.
Sincerely,
Dr. Warren
-NR
Dear NR: Pits of the fingernails are most commonly seen as part of psoriasis. The pits may be present for years before the rash develops. To the best of my knowledge it is not related to diet. You may try smoothing the nails by rubbing in a skin softener and filing the surface with a foam board. A dermatologist might provide some helpful treatment, but your best advice may come from a manicurist.
Sincerely,
Dr. Warren
-EM
Dear EM: Teething could cause some bleeding if there is a lot of swelling and a blood cyst forms around the tooth, but that is pretty rare. In 20 years I haven't had a patient complain to me about bleeding associated with teething. It is fairly common for blood or bloody mucus from the nose to be swallowed and then spit up or vomited. This is especially so if a child has a cold.If your child seems healthy and has no concerning symptoms I'm sure you needn't be alarmed; however, if the bloody spit up continues and you are not satisfied that you know what is causing it you should look into it. I think it is a good general rule that if a symptom is recurring or persisting and you are not certain it is harmless that you should see a doctor.
Sincerely,
Dr. Warren
-K
Dear K: The lumps you developed in your breasts during puberty are known as adolescent gynecomastia. Many boys develop these breast lumps as part of the changes associated with puberty because the testicles produce both estrogen (the female hormone) and testosterone (the male hormone). By mid puberty the estrogen levels produced by the testicles in some boys may cause breast swelling. For some boys the amount of swelling may be only a tiny knot whereas for others there may be some real breast development. As puberty progresses and the level of testosterone rises the breast lumps usually regress.If you were at the point of pubertal development to develop breast lumps at 15, it is safe to say that by now the lumps should have disappeared. If you have been checked by your doctor and have been found to be healthy including an evaluation to be sure that no glandular abnormality or testicular abnormality is contributing to the persistence of the breast lumps, then you should consult a plastic surgeon about a cosmetic repair.
Sincerely,
Dr. Warren
-ET
Dear : I often have parents ask me about constipation when in fact their infants are not constipated, so let's first make sure we're talking about the same thing. An infant is constipated if they have hard, infrequent bowel movements. After a while, constipated infants may have BMs more frequently but they are small and hard, usually like pebbles. Even this does not necessarily require intervention unless the infant is struggling to have bowel movements and crying with gas pains.Some of the reasons that parents ask about constipation when in fact their infants are not constipated are as follows:
If an infants stools are hard, a stool softener may help. The first thing is to add more water to the infant's diet. Sometimes a formula change may help since some infants have a softer stool on one formula over another. A bulk former like Malt Supex can help. Dark Karo syrup should not be used because it can have botulism spores and might cause infant botulism.
Sincerely,
Dr. Warren
Related question: before the previous event occured (same night) she gave me a hand job. None of the semen touched her but a few hours later (i didnt wash or urinate) the penetration happened. She is in the middle of her menstural cycle, a bad time I know. What is the likelihood of conception? ---thanks a bunch
-AD
Dear AD: Neither a man nor a woman who has had intercourse can be considered a virgin. If the act of intercourse is incomplete, does that make either participant a step closer to virginity? A penis can hardly accidentally enter a vagina, so why quibble over how far it went. The issue of virginity here is not a physical or medical issue. Many girls who have never had sex may not have an intact hymen from something as simple as bicycle riding. The state of the hymen, therefore, does not determine a girl's virginity. The question of virginity under these circumstances is a philosophical one, and the answer may depend on which one of you wants to know and why. For that matter, why is her virginity an issue and not yours? It was your penis that entered her vagina.If the issue is that your girlfriend is not ready for intercourse and doesn't want to go any further, she doesn't have to prove her virginity for her wishes to be respected. If you love each other, you respect each other. If your girlfriend is grappling with a religious issue, it is likely that her church would frown on your premarital activities regardless of whether her virginity was lost. Neither her purity nor her self respect should be defined by which side of the line you place loss of virginity on when you're standing right on the line either way. Virginity can't be defined by her intentions either (or yours) since many girls (and boys) have entered sexual encounters with no intention to have intercourse only to have intercourse in the heat of passion. This only points out how risky sex play can be since arousal doesn't heed logic or limits set previously when not aroused. If in the heat of passion the two of you went further than your girlfriend wanted to go, you have to respect her desire to take your relationship a step backwards at this time.
There is a small risk of pregnancy from the scenario you described, first because there may still have been some living sperm in your urethra (the part of your penis through which urine and sperm pass) and secondly, because sperm can come out during excitement if you come close to climax even if you stop before ejaculation. For future reference, you might also keep in mind that the spread of sexually transmitted diseases doesn't require ejaculation either. While ejaculation increases the risk of sexually transmitted diseases, genital contact without protection is more than sufficient.
Sincerely,
Dr. Warren
-JG
Dear JG: The chicken pox virus rarely crosses the placenta and so it rarely causes birth defects. When it does cause birth defects they can include skin scars, stunted growth of limbs, small eyes, cataracts, and mental retardation. Your daughter's doctor's lack of concern may be based on the fact that the chicken pox virus rarely causes birth defects and that the pregnancy is progressing normally. The truth is that no pregnancy has a guaranteed outcome, that the chicken pox virus only slightly increases the risk, and that there is no intervention that would alter the course of the pregnancy's outcome with regard to the chicken pox virus. Given the overwhelming likelihood that the baby will be healthy your daughter's doctor is wise to keep her outlook positive rather than focusing her attention on a small risk that she can't change.Sincerely,
Dr. Warren
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