14 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
-Mr. & Mrs. M
Dear Mr. & Mrs. M: The swelling in your child's face, neck, and jaw sounds like swollen lymph nodes. The ear pain is probably referred pain from those nodes. This could happen with Strep throat. If your daughter was put on an antibiotic for her ears that covers Strep it may get her better. Viruses can also cause swollen lymph nodes and don't respond to antibiotics.
Since you mention that her jaw is involved, the swelling could be parotid gland rather than lymph nodes. The most common cause of parotid swelling is mumps, but other viruses can cause parotitis.
The diagnosis or ear infection does not explain the swelling. If your daughter is not better by morning she should see her pediatrician.
Sincerely,
Dr. Warren
-JSKC
Dear JSKC: Some people do sweat more than others. Anxiety may contribute to the problem. Hyperthyroidism may cause excessive sweating. It also tends to cause weight loss, rapid heart beat, and nervousness. If you have any of those symptoms you should be checked by your doctor.The best non-prescription antiperspirant in Mitchum. Deodorants do not necessarily have antiperspirants in them. If that does not help you should ask your doctor about a prescription medication called Drysol.
Sincerely,
Dr. Warren
-SP
Dear SP: There is nothing wrong with doing what it takes in terms of comforting your child to get her to fall asleep. The problem is that, even though going to sleep is an unavoidable necessity, how we fall asleep is a learned behavior. If a child has learned to depend on your intervention to go to sleep she will continue to demand it, and that includes if she wakes in the middle of the night. The problem becomes even more difficult in the child who hasn't learned to go to sleep in his crib by 6 months of age because between 6 month and 8 months most babies develop separation anxiety.
Some babies by nature are more easy going, cry less, and handle separation better than others. But even if your baby is the easy going type there are bound to be times when you will make her cry. Children cry for what they want. A young child can't distinguish between what he wants and an urgent need. Babies' cries are, by their very nature, difficult to ignore. Human parents are programmed to respond to their babies' cries. If they could be ignored easily, human beings would not have survived evolution because babies are totally dependent on their parents. But even though, to a baby, all his needs are urgent, a parent has to be able to decide what is urgent and what isn't.
Your aim is to get your baby to sleep in her own crib and not demand frequent interventions from you during the night. She doesn't know that she can manage without you. She will not know it without experiencing it. And depending on your child, it may not be possible to avoid her crying for her to experience falling asleep without your help. In fact many children continue to cry about being put into their cribs for a long time, but most learn within a few days to quiet and go to sleep within a few minutes. If your daughter is a real screamer it could take a week or two to get her crying down to a tolerable level, but it will get there.
Many parents ask how long to let the baby cry as if there is a set length of time. If you feel that your baby's cry might indicate a problem or that it is so intense that she won't calm down without your intervention, you should go in and check her. If you feel you must calm her, keep it brief and get her back into her crib awake. If you set a time limit for yourself you will teach your child to cry at least that long in order to get what she wants.
I am not a believer in being tough with kids just to show them that life is tough, or that they can't have everything they want, or that you are in charge. Parents should comfort their children and give them as much love and affection as they can. But crying is a fact of children's lives. And if you plan your child's upbringing around avoiding crying, you will not be helping her to learn to deal with the inevitable tough spots that life brings her way. In fact, if your daughter is sensitive to the extent that she cries easily or if she is a screamer when she doesn't get her way, you had better learn to live with her tears or you'll find that she is in charge, and in the end that will not make her a happier or healthier child.
Sincerely,
Dr. Warren
-CS
Dear CS: Asthma is an inflammatory disease of the lungs. Prelone is a steroid used for its potent anti-inflammatory effect. If an asthmatic is having difficulty controlling his asthma even with adequate bronchodilator therapy such as albuterol by nebulizer, a course of 3-7 days of steroids under the supervision of a physician can be very helpful in bringing the symptoms under control. Steroids are not very useful when taken intermittently. They provide no immediate therapeutic benefit for wheezing and they can have many side effects when taken for a long time; therefore, the best way to take them is to give a full therapeutic dose under the guidance of a physician and give it for the minimum amount of time necessary to control the wheezing, usually not less than 3 days.If a child has a frequent need for steroids or even for bronchodilator therapy, he should be on a maintenance inhaled anti-inflammatory medication such as cromolyn or an inhaled steroid.
There is no special diet for asthma. If your child is allergic to any foods they should be avoided, but asthma symptoms are more commonly provoked by inhalant allergies than foods.
It sounds like you should have your child see his doctor for adjustment of his medication since his asthma is not controlled on his current regimen.
Sincerely,
Dr. Warren
-Thanks,
Mom and Dad
Some time ago there was some research that showed a higher risk of cervical cancer in women who had uncircumcised partners. It was concluded that this was somehow related to cleanliness. The problem was that the data was not analyzed adequately to see if there were any other explanations. It turned out there was. In this country, circumcision was more common in higher socioeconomic groups. On the other hand, earlier sexual experience and multiple partners were more common in lower socioeconomic groups. (This was before the '70's) The earlier sex and multiple partners in the lower socioeconomic group resulted in a higher incidence of sexually transmitted diseases which was the real culprit in cervical cancer. The association with lack of circumcision was accidental.
A few years ago the American Academy of Pediatrics took the position that there was absolutely no medical reason to circumcise newborn boys. More recently the data show a decreased risk of urinary tract infection (UTI) in the first year of life for circumcised boys; however, the risk of UTI in boys during the first year of life is sufficiently low that it certainly wouldn't make circumcision necessary anymore than it would be worth removing healthy appendices to avoid a few cases of appendicitis.
For a very complete discussion of these issues (with a clear anti-circumcision bias) point your web browser at http://www.cirp.org/CIRP/pages/parents/.
Sincerely,
Dr. Warren
-HM
Dear HM: Chicken pox looks like red oval patches with a dew drop sized water blister in the middle. The blisters open and crust. Then a hard scab forms. As more pox continue to break out you will see them in all stages of development. From your description your child may have chicken pox.There is no cure for chicken pox. It will run its course in about 7-10 days. Children with chicken pox can be treated with Tylenol for fever and Benadryl or another antihistamine for itching. Adults and older teens should be treated early in the course of chicken pox with Zovirax, an antiviral medication your doctor can prescribe. Children should not be treated with Zovirax since they may have side effects from the medication and most children don't get as sick as adults do with chicken pox.
Sincerely,
Dr. Warren
Also, for about a month she has been getting 2 solid food feedings per day (AM she gets 2 tbsp of rice cereal and 1/2 jar of fruit and PM she gets 1/2 jar of vegetable and 1/2 jar of fruit). She also gets 5 bottles of formula totalling 24-25 oz. per day. She often won't take the bottle with her feeding of solid food. This means we are having to feed her between 5-7 times per day. Is there any way we can better schedule her feedings? She doesn't seem to want to take more than 6 oz. per bottle. Also, is she getting enough? She weighed 15 lbs., 4 oz. at 5 months.
-TE
Dear TE: A change in sleeping patterns can be easily precipitated by an illness. You are wise not to feed your daughter when she wakes during the night. On the matter of picking her up, it's a judgment call. You should always keep your intervention minimal with the intention of getting her back into her crib as quickly as possible and while awake, but if you feel she is becoming progressively more awake and hysterical it may pay to comfort her briefly. There's no rule to follow. If you find that it makes things worse or the night waking increases then you'll want to avoid intervening. But you'll still want to check her to be sure everything is okay.At six months she may be teething and having separation anxiety. These may contribute to the changed sleeping pattern. Since your daughter still sleeps through some nights you can be sure that she will soon sleep through all again, but it's impossible to predict when.
Your daughter's weight is just above the 50th percentile for her age which indicates average growth. Therefore she must be eating appropriately. If she doesn't want a bottle along with solids you will have to continue her current pattern until she is ready to eat more at a meal. Remember, even though adults eat 3 meals per day they have coffee breaks and snacks. Three meals per day is more of a social institution than a natural human rhythm.
Sincerely,
Dr. Warren
Thanks again.
-KS
Dear KS: Normal newborns spend between 12 and 22 hours per day sleeping. If you have a child who sleeps 22 hours you have a lot of peaceful time between feedings. If your child only sleeps 12 hours a day he spends a lot of time awake and that usually means a lot of time crying since 1 month olds don't know how to comfort or amuse themselves. Newborns also have different temperaments. Some are placid and some are easily stimulated with a low threshold of frustration. If you have a 12 hour awake low threshold kid, it can be very draining.Lots of mothers who have 12 hour awake, low threshold kids describe them as crying all the time, but in reality they are calm for feedings and can be calmed by walking with them, rocking them, singing to them, talking to them, etc. The trick is to rock gently and talk softly so as to not over stimulate the child. If, on the other hand, your child really is screaming all the time, you have to think of colic.
Colicky babies cry all the time and want to feed all the time, but they often get angry during feedings because it doesn't relieve their discomfort. They may even be fretful during sleep. If a nursing child is colicky, Mom has to look at her diet to be sure she isn't eating spicy foods or drinking too much cow's milk. Colicky formula fed baby's deserve a trial of a hypoallergenic formula such as Alimentum or Nutramigen.
Colic is usually outgrown by 3-4 months. Babies generally become increasingly social and interactive with their parents so that even by 2 months of age parental intervention is more successful.
If your baby cries all the time you need to sometimes leave him crying after you've determined that everything is okay. If you're always torn between taking care of your crying baby and doing whatever else needs to be done, you won't get anything done, and you won't spend any relaxed time just enjoying your baby. Let him cry for a few minutes while you do a wash or prepare a meal. And when you have free time relax in a comfortable chair and just hold your precious baby and enjoy each other.
One of the things mothers of screechy babies need is support such as talking to other mothers of screechy babies. When you're exhausted and the baby never gives you a break it sometimes makes you so tense that your tension adds to the baby's irritability. And you may feel guilty if you have anything less than a loving thought for your infant from time to time. You need to know that you are not alone, and that your baby isn't crying because of anything you are doing.
Make plans to take a break from your baby. Get grandma or some other trusted baby-sitter to spend an hour with the baby so you can take yourself to a beauty parlor or some other thing just for you. Perhaps Dad can spend an hour with the baby so you can relax in a bath or even go out in the evening. And most important, you and your husband deserve some time just to be with each other. Being a mother is a full time job just like being a pediatrician with night call and weekends, but I couldn't keep up what I do without a break, and neither can you.
Sincerely,
Dr. Warren
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