7 April 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
I thank you in advance for your time and consideration.
-MM
Dear MM: You didn't mention your son's age. This is important because if he is a newborn, he may have a blocked tear duct and he should also be checked for chlamydia which can cause conjunctivitis and won't respond to sulfacetamide.
Sulfacetamide is an excellent choice of antibiotic for treating conjunctivitis, but some people are sensitive to it and it may become irritating. After a few days some people will develop enough eye irritation if they are sensitive to an eye drop that it may make the eye look redder and have more discharge.
Infants are often difficult to treat with drops because they cry them out. While it is sometimes a little more difficult to put an ointment in the eye, that would be what I would try with an infant who hasn't responded to drops. Since the sulfacetamide has not worked your doctor might choose an erythromycin or tobramycin, or any of the large variety of non-sulfa antibiotics.
You should probably have your doctor check your son again. Young children with conjunctivitis have a high frequency of ear infections. While it might be reasonable for your doctor to try a different antibiotic in ointment form, if he doesn't like the way the conjunctivitis looks he may want an ophthalmologist to see your son.
Sincerely,
Dr. Warren
-EV
Dear EV: For a complete explanation of the genetics involved in consanguineous unions (relatives having children together) check my 25 January 1997 column.The risk of any consanguineous union producing a child with a genetic disorder is dependent on what, if any, deleterious recessive genes the family may carry. When two people (related or not) who carry the same recessive gene produce a child there is a 25% risk that their offspring will have the genetic disorder. The issue with consanguineous unions is not that the risk of an affected child is greater than 25%, but since relatives have genes in common, the closer the relationship the greater the risk that they might share a recessive gene that is rare and have an abnormal child as a result.
Another way to look at it is as follows. Suppose you have the gene for a serious but rare genetic disorder. As a carrier you have no symptoms at all. Since you have no symptoms, you are not aware that you carry the gene. Since the gene is very rare there is no family history of children affected by this genetic disorder because the likelihood of two people with the same rare gene getting together is so remote that it hasn't happened in your family. But since your family carries the gene, you are not the only person in your family who has is an asymptomatic carrier. If you have a child with a relative your risk of having a child with this rare disorder could be up to 25% depending on how many of your relatives carry the gene; whereas if you have a child with somebody who is not related to you, since the gene is rare, your risk is almost zero. Now consider the possibility that two relatives could be carrying multiple genes for recessive disorders and not be aware of it. Because relatives have many genes in common, the closer the relationship, the greater the risk of having offspring affected by multiple serious (or not so serious) genetic disorders.
If a family does not carry any problematic recessive genes, than a consanguineous union actually poses no genetic risk, but it's a gamble because there is no good way to know. On the other hand, if there is any family history of deformities or inheritable disorders, the risk is considerable.
Sincerely,
Dr. Warren
We have 3 sons and when colds hit our family, he is always hit the worst. He developed a cold about 5 days ago as did his brothers. They are fine but he is still ill.
What I am concerned about is his fever. He will be fine during the day but by late afternoon a fever starts and by the middle of the night is is up to 103. The next day he will again wake without a fever and the cycle will start again. He has no signs of an infection.
Why does he only get this fever in the evening and night? This is the fourth day this has happened.
Thank-you
-RS
Dear RS: Sometimes when two people get the same illness one gets much sicker than the other. The reasons for this variability in how illness expresses itself is not always clear. Some children are prone to ear infections when they get colds because of the shape of their face, the size of their adenoids, and the condition of their Eustachian tubes. Other children may develop bronchitis or pneumonia more easily because they have asthma, or their asthma may get worse when they have colds.
Some children just tend to run higher fevers than others whenever they get sick because that's how their body responds to illness. There are differences in people's immune systems that make one more susceptible to one type of infections while the other may be more prone to something else. Differences in diet, sleep, an hygiene (especially hand washing) can affect susceptibility to infection. In families with several children the youngest often gets hit hardest because he is exposed to all the infections his older siblings bring home from school. The older children have a better developed immune system and don't get quite as sick or take quite as long to recover.
Most virus infections cause fever for 3-5 days, sometimes longer. The normal body temperature tends to be higher in the evening because of the body's natural rhythm. This same rhythm tends to make fevers higher in the evening as well. Fever is just a sign of illness. It is part of how the body fights infection. Fever itself is rarely dangerous, but when your child has a high fever or a persistent fever, or if he seems sick or has any worrisome symptoms, he should be checked by his pediatrician.
107 degrees is an unusually high fever. You should probably ask your pediatrician if there was anything unusual that contributed to the fever going so high.
Sincerely,
Dr. Warren
-BV
Dear BV: Most croup is caused by a virus and tends to be seasonal, usually in the fall. Some children get recurrent croup because of allergies, and some children get croupy whenever they have colds. Croup differs from asthma because in croup there is inflammation in the upper airways around the trachea and larynx whereas the inflammation in asthma is in the lower airways - the bronchial tree. The inflammation in asthma provokes wheezing with spasm of the airways. The albuterol relieves the spasm. Croup does not cause spasm of airways so albuterol is not helpful. The inflammation in the trachea and larynx with croup results in a barky sounding cough. If the inflammation is moderate it causes narrowing of the upper airway which results in noisy breathing. If the inflammation is severe the airway becomes narrow enough to cause difficulty breathing.Croup tends to be worst in the middle of the night and the wee hours of the morning. It improves with steam and so it is a good idea to keep a humidifier or vaporizer going. If a child wakes up croupy it can be relieved by turning on the hot shower, filling the bathroom with steam, and letting the child breathe the steam. If a child has labored breathing that isn't relieved by steam then an emergency room visit for treatment is needed.
Since croup is caused by inflammation, it can be treated by decreasing the inflammation with steroids. If a child has stridor (the noisy breathing of croup) during the day he will likely have a difficult night. This might be avoided by treating with a short course of steroids. Or if the child had a problem with croup the night before, his doctor might elect to treat with steroids for a day or tow until he is sure the croup has improved.
Since the airways get larger as a child gets older croup tends to be less of a problem in bigger children. It is hard to state an age by which croup will be "outgrown." Although it is rare, I have treated a few preteens for croup.
Sincerely,
Dr. Warren
-CF
Dear CF: Intertrigo is a condition which develops when two skin folds rub together and don't get air. If the area is weeping you can try using an astringent such as Burrow's solution on it to dry it. Apply the hydrocortisone cream 3 times per day. If you are using the 1/2% hydrocortisone cream switch to the 1% hydrocortisone cream. If you are using the 1% cream and increasing to 3 times daily and using Burrow's solution compresses does not help, you will need a prescription cream and will need to see your pediatrician or a dermatologist.Sincerely,
Dr. Warren
-RR
Dear RR: Some nursing babies are easy to give bottles to. Others are impossible. If you have a child who refuses to take a bottle after all the things you've tried you're kind of stuck. The reason - Your infant has made her choice clear. She knows what she wants. The only way she'll take something else is if she has no choice. But my guess is that she always has a choice, because when she gets absolutely hysterical you know what will work to calm her down. And you find it impossible to refuse to give her your breast.My advice. If she's doing well on nursing she's probably better off not taking bottles. Some babies get very confused when they switch between bottle and breast. Try to plan being out of the house around her feeding schedule, but do go out. And if you must leave a bottle for her, don't call home to find out if she's taking it, because even if you don't run home your time out will be ruined. If you're not there she'll have no choice but to take the bottle. And the worst thing that will happen if she doesn't is that she'll scream for a while.
In a few month's she'll be ready to start some solid food and may even be able to take some liquid from a cup. This will take some pressure off you for nursing.
Sorry there isn't a better answer, but with all the things you've tried you've pretty much covered all bases.
Sincerely,
Dr. Warren
Sincerely,
RR
-MA
Dear MA: If you are doing a web search for information about hair loss (other than male pattern baldness) the term for hair loss is ALOPECIA.The main causes of hair loss in children are:
Sincerely,
Dr. Warren
We have a 10 month old girl who's suffered with chronic ear infections. They began at only 2 months of age and she has been on antibiotics more than half of her life. This goes against my grain, being a health nut, I feel that her own immunity will not be strong. Anyway, two weeks ago the Dr. put tubes in her ears and she only became worse. She has always wanted to be held fairly upright (could never cradle her) and she constantly gags herself. Since the tubes, her ears have been draining a yellow/green/brown fluid. We took her back and the doctor vacuumed her ears and looked at the fluid and said it was pseudomonus and that oral antibiotics won't kill it. So we began the drops in the ears 3 x/day of chibroxin. Do you have any advise about our situation. How could she have gotten this bacteria and what do you think about all the antibiotics and motrin and tylenol we constantly have to give her?
Thank you so much!!!
-Mr. & Mrs. T
Dear Mr. & Mrs. T: I can understand your frustration at having a child who is constantly sick and on medicine. Finally you do surgery which is supposed to solve the problem and it doesn't work. The grandson of one of the ladies who works for me went through the same thing.I don't like to have children on antibiotics any more than necessary, but sometimes when a child has constant ear infections there is no choice. There have been several articles recently about treating ear infections with shorter courses of antibiotics to avoid the development of resistant strains of bacteria. Recently, in England they started not treating every ear infection. While this was beneficial in some cases they found an increase in the complications such as mastoiditis. Given your child's history, I don't think she would qualify for less antibiotics. Sometimes medication is necessary.
Most children who get tubes do very well. In fact some kids do so well their parents can't understand why we didn't recommend it earlier. But no treatment is a panacea. I have never heard a good explanation as to why children continue to get ear infections after tubes. Pseudomonas is not a usual organism to cause middle ear infections. Pseudomonas is not an infectious organism. It is in the environment and tends to grow in moist areas. It is a problem in hospitals in respiratory equipment and it is a problem for children with cystic fibrosis. In this case it is probably a secondary infection because the ear is moist and draining. Treatment of draining ears with drops is fairly standard.
If the tubes don't help keep your child free of ear infections, she may benefit from a long course of a low dose of antibiotics. We use Gantrisin or Amoxicillin once daily for 1-3 months as prophylaxis to allow time for the middle ear to heal.
Sincerely,
Dr. Warren
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