28 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
-LW
Dear LW: With time, sharp edges on teeth may wear down somewhat. Whether or not to see the dentist depends just how big a chip and how sharp a point you're talking about. If the point is fairly small it is likely that anything that would result in an injury from the point would result in an injury without the point. If the chip is large the tooth may risk decay. If the teeth are chipping easily they should be checked to be sure that they are not decayed now.
Sincerely,
Dr. Warren
-RTA
Dear RTA: Night time leg pains in children are generally known as growing pains. They are not the result of growing. They are generally caused by muscle cramps. They typically occur at night when the child is at rest, especially after a very physically active day. The clue that they are not worrisome is that they only occur while the child is at rest rather than during activity. They don't interfere with activity or result in the child becoming less active. And they don't cause a limp.
If your daughter's leg pains fit my description of growing pains you can treat them with reassurance and massage, and Tylenol if it seems to help.
Sincerely,
Dr. Warren
-(anonymous)
Dear Sir: By the time you get this response it will be morning. But a general rule to follow is that pain is your body's way of telling you something is wrong. If the pain is extreme, it demands immediate attention. If the pain is a result of a chronic condition and you know what to expect from it, you can decide how urgently you need to be seen based on your tolerance for the pain and your understanding of the circumstances.
When pain is a result of an acute injury, the severity of the pain can also serve as a guide to the urgency for treatment. But you must also assess the nature of your injuries and, if the pain is tolerable, decide whether there is anything that might require urgent attention, or if there is a risk of complications without urgent attention. So, for example, if you think you have a fracture, or you have an open wound that needs sutures you need immediate attention. Likewise if there is any possibility of internal injuries or there is significant blood loss. And finally, if there are any secondary problems such as pain from your heart, difficulty breathing, etc., those would need attention immediately.
Sincerely,
Dr. Warren
Also, I had them measure his height and he is now 33 1/4 inches. I was told that he is out of the range and there is a concern. I should talk to my Pediatrician when he comes back for his checkup in 10 days. He has always been in the 10 percentile range. I am a little bit anxious about this. What should I be concerned about? In every other way he is just fine.
By the way, I am 5' tall and my husband is 5'10". So we're not the tallest people.
Thank you,
-SH
Dear SH: The frequency with which your son has had ear infections can be frustrating, but this does happen to some children. Even though the congestion of cold tends to cause ear infections in the child prone to them, congestion is not necessary for an ear infection to develop. If a child has persistent middle ear fluid, that increases his risk. Enlarged adenoids can contribute to the problem. Children with conjunctivitis (pink eye) have an increased risk of ear infections.
Children who have persistent middle ear fluid for more than 4 months, especially if there is associated hearing loss may require myringotomy and tubes. If those children have enlarged adenoids, removal of the adenoids can also help. In children who have recurrent infections and persistent middle ear fluid, long term, low dose antibiotics can sometimes help prevent reinfection allowing time for healing of the middle ear with resolution of the fluid. If a child goes several months between infections with complete clearing in between, treating each infection may be the only option. You might wish to clarify your child's status regarding his ears with his pediatrician.
A child whose height is below the 3rd percentile does not necessarily have a medical problem interfering with his growth, but on a statistical basis, when something is outside the normal range there is a greater likelihood that there is a problem. If your child's height percentile had always been at the 10th percentile and suddenly drops below the 3rd percentile it indicates a recent slow down or stoppage of growth. Another measurement or two over the next few months may be useful to confirm and clarify this. It is possible to be small and have normal growth below the 3rd percentile, but a continued slow growth pattern would require evaluation.
The causes for poor growth are many. A review of your child's nutrition and any recent changes in diet, activity, and possible stresses, would be useful. Chronic illness can play a role in poor growth, but I have never seen any correlation with recurrent ear infections. A review of familial growth patterns can suggest whether this slow down is to be expected. A bone age x-ray can aid in determining just what degree of delay there is.
If the growth pattern is determined to be abnormal your child may need an endocrine evaluation to rule out glandular disorders, the most important being thyroid deficiency. To check for chronic infection a urine culture might be needed. Evaluations of major organ systems such as heart, liver, and kidneys might be undertaken with blood work, urinalysis, EKG, chest x-ray, echocardiogram, etc. The place to start, is with a complete check up by your pediatrician.
Sincerely,
Dr. Warren
Also, she seems to have started "temper tantrums". If I take her away from something she goes into a fit. I try to give her other toys & talk to her but nothing seems to work. Any suggestions?
Thank you
-KA
Dear KA: If your pediatrician has found your infant to be growing well on only one bottle of formula per day, she must be getting her nutrients from her other food. If she eats yogurt, it is ounce for ounce the nutritional equivalent of milk. The American Academy of Pediatrics recommends continuing formula or nursing until the baby is 1 year old. After that you may switch to whole milk.
Since your daughter doesn't have enough language to express her wishes and feelings, temper tantrums are her way of expressing her frustration at not getting what she wants. As the adult controlling her life it is reasonable to try to distract her, comfort her, and try to avoid situations that will provoke tantrums when it is reasonable to do so, but ultimately, your daughter needs to learn to deal with the fact that she can't always have what she wants. Even though you may desire to comfort her, she will feel better knowing that you are in charge. Her tantrums cannot rule the situation. It is never a good idea to give in to children just because of tantrums because that encourages more tantrums. If you are consistent in your handling of her tantrums, she will learn to live with not getting her way and her tantrums will become shorter and less frequent.
If your efforts to distract or comfort your daughter fail to stop her tantrums, it may be best to just put her in a place where she cannot hurt herself and ignore her, allowing her to calm down on her own.
Sincerely,
Dr. Warren
I have a 14 month old who, for the first time in his life, has what I thought was just a cold. Seeing that it is his first time being sick, I hope you can understand why I am writing to you over something, probably very trivial. Anyway, the GP here told me to give my son Rondec syrup for his runny nose. He has had this symptom for about a week. He has been fussy, but has not had any fevers nor any other symptom. His mucus has been getting more sticky and now has a greenish tint off and on. I realize that a "green" nose is a warning sign for an infection, but do you think that antibiotics wouls be a better route? I suspect that his molars may be coming in...but I am not sure.
My other question is about actually giving him his medication. He refused to take them. I've basicly had to force it down his throat! Do you have any advice on administering is medication?
Thank you for such a wonderful web-page.
-JJ
Dear JJ: A persistent discolored nasal discharge in a child who has had cold symptoms several weeks or more may be a sign of a sinus infection. As a cold begins to dry up the mucus thickens and the dry mucus does have a greenish tinge. This is perfectly normal. Antibiotics are not at all useful for treating colds. If your child should start to act sicker, run a high fever, or his symptoms do not resolve, you will want to have him checked again by his doctor.
I applaud your GP for not rushing to start antibiotics since far too many physicians use antibiotics inappropriately or just in case. This kind of overuse of antibiotics has been causing a rapid increase in the number and types of bacteria resistant to multiple antibiotics.
Getting children to take medicine they don't want can be quite a chore. It is natural to refuse something that tastes bad. When you get a new medicine, ask your pharmacist what things it can be mixed in. Some children will take a medication mixed in juice or poured onto ice cream. Sometimes offering it in a small cup instead of a medicine spoon can help. Some children take chewable medications better than liquids. If your child gives you a really hard time with a particular medicine, you should ask your doctor if there is a better tasting alternative.
Sincerely,
Dr. Warren
-G
Dear G: At 8 months 27 inches is around the 50th percentile and 23 pounds is above the 95th percentile, so your daughter certainly weighs too much for her height. However, before you put her on a diet, you need to review her growth chart with her pediatrician. If she has been above the 95th percentile for weight for a while and her weight gain continues along the same curve, there may be no need for much intervention. On the other hand, if her weight has been steadily crossing percentile curves, it is reasonable to intervene.
At 8 months a child should not need to eat every 3 hours. If her weight gain has been excessive (crossing percentile curves) try offering her water in her bottle in an effort to stretch out the distance between her meals to 4 hours. You can also add 1 to 2 ounces of water to each 8 ounce formula bottle. If you are giving her juice in a bottle try switching to a cup to limit her juice intake. At mealtime set a limit on what you intend to give her. Just because she doesn't turn away from food doesn't mean she needs to keep eating. She may surprise you and be satisfied with what you decide is enough. Finally, be sure not to respond to all of her cries with food. Children can learn to calm in response to feeding, but if it isn't mealtime, perhaps she can be calmed and entertained without food. Try a variety of approaches to distract her before you offer her food unless it is mealtime.
Sincerely,
Dr. Warren
-SG
Dear SG: Weight lifting does pose some risks to a growing child, but it certainly does not interfere with growing. At 15 most adolescents should be able to lift weights. What you are ready for is more dependent on your degree of pubertal development rather than your age. Some boys at 15 are just starting puberty and others have adult bodies. By mid to late puberty the level of testosterone is high enough to increase muscle development. Prior to that weight lifting should be kept to light weights aimed at toning muscles and building endurance. Even after mid puberty adolescents who are still growing should be aware that the growth centers of their bones are more prone to injury than bones that are fully fused. Therefore, it is risky to rush to higher amounts of weights to bulk up. If you build up gradually and balance your exercises so that all muscle groups get used, your muscles should be strong enough to handle the load without risking injury.
Sincerely,
Dr. Warren
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