2 June 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
-K & J B
Dear Mr. & Mrs. B: The incubation period for chicken pox is 12 to 21 days from exposure. If your daughter gets the vaccine now, it won't hurt her if she then develops chicken pox, and if she doesn't end up with chicken pox from this exposure she will be protected in the future. It would be too late for the vaccine to protect her against the current exposure. The only thing you can do about the current exposure is wait and see if she gets it.
Sincerely,
Dr. Warren
I've been told by my parents that, when I sleep, I have a problem with constantly flatulating.. its really embarrassing and I don't know what to do about it.. I know its not because of my diet, I eat properly and no foods that I'm allergic to..
This might sound trivial but I'm supposed to be looking at colleges soon, and I'd really like to go away to college. Unfortunately, I couldn't board somewhere in another state with a dorm roommate like I want to with this problem, I just couldn't handle the embarrassment. Any advice you could give me on any vitamins I might take or anything of the sort would be greatly appreciated.
-DJ
Dear DJ: There isn't any medical condition that would make a person flatulent only when he sleeps, so we have to look to your diet and your bowel habits for answers. Even if you eat properly, some things will increase you chances of being gassy. If you don't have even a hint of gas during the day, since meals can take up to three hours to be digested and start their course through the intestines, we have to look at your dinner.
Spicy foods may increase your gas. If you are somewhat lactose intolerant, milk and some dairy will cause a problem. Eating rapidly and gulping results in air swallowing. Any swallowed air that isn't belched up has only one way out after it exits the stomach. Carbonated beverages can add to the load of gas. Sugar-free products sweetened with sorbitol can cause gas. Certain vegetables such as beans, cauliflower, broccoli, onions, and peppers make some people gassy. Eating a larger meal increases intestinal activity. It may not be your habit to have a bowel movement at night, but if you have stool that has moved down to the rectum that will increase your flatulence until you have a bowel movement.
Vitamins are not likely to help your problem. An elimination diet where you try eliminating certain foods to find the culprit might. Simethicone (found in Mylicon, Gaviscon, Gas-X and other anti-gas preparations) may relieve the problem by eliminating some of the gas bubbles.
If you are unable to completely eliminate the problem, don't focus on it as a problem for college life. Everybody worries about something when they enter a new environment, but you form relationships, and just like you don't have to be embarrassed at home, you don't have to be embarrassed among friends. It's been a long time since I was in college, but from what I can tell, many young men that age still turn gas into a sport.
Sincerely,
Dr. Warren
a real doctor
-CH
Dear CH: Unfortunately, nausea is high on the list of side effects for all birth control pills. In spite of all the sophisticated tests that doctors can run, the best clues usually come from listening to what our patients tell us. Since you say that your problem began around the time you started taking birth control pills, the most reasonable thing to do before you try any additional tests is to stop all birth control pills for at least two months. If that solves the problem, you have a choice to make. If it doesn't solve the problem, you need to consult a gastroenterologist for complete evaluation of your gastrointestinal tract including liver and gallbladder.
Sincerely,
Dr. Warren
He had been eating about 5-6 ounces 5 or 6 times per day, and suddenly has dropped to about 4-5 ounces 5 times a day. Is this drop a cause for concern? He seems happy and healthy, is not particularly fussy and does not seem to show any other changes. He sleeps thru the night. I have noticed he eats more at daycare than at home though.
He has recently had a cold which he is on Amoxicillin for (I don't know if that has any relevance) but other than that has been perfectly healthy.
Any thoughts? Is there need for concern?
Thank you so much for your time and help...
-JM
Dear JM: Sometimes children may decrease their food intake when they have a cold. Even if they don't seem ill, it may be difficult for them to eat with a stuffed nose. Antibiotics can contribute to a loss of appetite by upsetting the stomach. After recovery from an illness it may take time for the appetite to return to normal. If your infant seems happy and healthy, the best way to determine if he is eating enough is for your pediatrician to review his growth chart after he is weighed and measured at his check up.
Sometimes infants begin to eat less as their growth rate slows down, but 2½ months is a little early for that to happen. If he eats 20 ounces per day of formula he would meet his requirements to maintain his weight, but he wouldn't have enough calories for growth. To meet his requirements for growth you're looking at closer to a 27 ounce per day minimum. If your son's intake remains below that his, growth should be checked by his pediatrician.
Sincerely,
Dr. Warren
I am breast feeding. I've tried eliminating dairy, caffeine, spicy foods, acidic foods, gas inducing vegetables, as well as any food I ate which seemed to bring on an attack, from my diet. I tried nursing her on a bottle with soy and this made matters worse. I've used Mylicon drops, a pacifier, herbal tea in a bottle, a baby swing, a vibrating seat, and much, much more nothing seems to help.
There is a history of food allergies on my husband's side of the family. I've already tried eliminating these foods from my diet to see if it would help
-SC
Dear SC: You don't say how old your baby is. Colic tends to occur during the early months an usually improves or resolves by 4 months of age. There hasn't been any medication proven to be truly effective for colic. Mylicon is totally safe to use and helps to relieve gas, but it has never been shown to be effective for colic. Levsin is an antispasmodic. Some babies may have significant side effects from antispasmodics, and, as in your situation, very little benefit.
Nursing infants generally have soft to watery stools, but it is not unusual for them to go 4 to 5 days between bowel movements. If you must help your infant to have a bowel movement, rectal stimulation will work, but at some point babies must be allowed to develop their own rhythm for bowel habits. I'm sympathetic to the fact that bowel movements are an unpleasant experience for her, but this will only improve if she develops her own bowel habits with as little intervention as possible.
If there is a strong family history of allergies any formula you offer should be hypoallergenic such as Alimentum or Nutramigen. Soy is as potent an allergen as cow's milk. Your best bet is to nurse exclusively and pay strict attention to your diet. Any dietary changes you make can take several days to produce any benefit so don't be too quick to return potential problems to your diet just because you haven't seen results. For more information on your diet and nursing point your web browser to http://www.parentsplace.com/expert/lactation/diet/.
Sincerely,
Dr. Warren
What are the recommended treatments for recurring ear infections-strep throat? length of treatments?
Thank you.
-KR
Dear KR: The routine duration of treatment of ear infections is 10 days, even for recurrent ear infections. In fact, in some circumstances doctors are trying shorter courses because of concerns about emerging resistant strains of bacteria. Treatment should generally be started with a narrow spectrum antibiotic like amoxicillin. Narrow spectrum antibiotics kill a smaller variety of germs while broad spectrum antibiotics kill a larger variety, but a narrow spectrum antibiotic works just as well on an infection as the broader spectrum antibiotic as long as the germ is sensitive (not resistant) to it.
If an ear infection is not fully resolved after 10 days it is usually the result of physiology rather than antibiotic resistance. What I mean is that the congestion of the ear which led to the infection has not resolved sufficiently for the ear to clear. Nonetheless, since there is some risk that bacteria remaining in the middle ear are resistant to the most recently used antibiotic, it is usually wise to continue treatment with a different antibiotic. The choice of antibiotic should generally go from the narrower spectrum to the broader spectrum antibiotics with each time continued treatment is necessary.
If a child has recurrent ear infections (ear infections clear but recur again soon after clearing) and persistent middle ear fluid, antibiotics may be used long term (one to several months) in low doses to prevent reinfection and hopefully break the cycle.
The concept of treating infections for 10 days comes from the studies that show the lowest relapse rate for strep throat after 10 full days of treatment. Strep has not become resistant to penicillin, but as the tonsils become less inflamed the antibiotic levels in the tissue and saliva drop leaving some people with strep still living in their throats but not invading the tissue. Some of these strep carriers will have a relapse within 48 hours of stopping their medication. Others will revert to the non-carrier state within a few months. Medication is rarely helpful for treating carriers (meaning not sick.)
Relapses should be treated with a 10 day course of penicillin or erythromycin (or penicillin allergic patients) just like the initial infection. Broad spectrum antibiotics are not better for treatment and should not be used because it encourages the development of resistant bacteria in the environment.
Multiple relapses should be treated with an eye toward eradicating the carrier state. Rifampin given for the last 4 days of penicillin treatment can help. Treatment with a 10 day course of Duricef may also work. Before embarking on these treatments it is a good idea to be sure the patient has been compliant with a 10 day course of treatment. If not, an injection of LA Bicillin will do the job. On occasion I have resorted to giving penicillin twice daily for one or more months to prevent relapse. If a child has large, cryptic, diseased tonsils, a tonsillectomy may be necessary to prevent relapses.
Sincerely,
Dr. Warren
-J & T E
Dear Mr. & Mrs. E: By your description your daughter has "Geographic Tongue," also known as "Benign Migratory Glossitis." It consists of denuded, smooth areas, generally not painful areas, that move around on the tongue. The name "Geographic Tongue" refers to the appearance similar to a topographical map. This is considered a normal variant of tongue appearance. The denuded areas are sometimes a little sensitive or sore, but this rarely presents a problem. To most people, the main concern is that the tongue looks weird.
There is no treatment, but there is no need for treatment. I have personally had a geographic tongue for as long as I can remember. No need for worry. It is harmless.
Sincerely,
Dr. Warren
Dr has done urinalysis to r/o UTI. Urinalysis is neg, but culture is not back yet. Blood was drawn today. As of Monday, no ear infection present, however today, double ear infection was found. Dr feels this is secondary to fever??? Augmentin was prescribed.
In addition, she has decreased appetite.
I know the possibility of Roseola exists, but we won't know until fever breaks.
What do we do in the meantime?? Is there anything else?? 106.3 is nothing to mess around with.
We are also eager to find a diagnosis not oly for our daughter's sake, but I am 32 weeks pregnant and need to know if whatever she has can harm the unborn child. Furthermore, if the fever resolves without a difinitive diagnosis, should we be concerned for any future recurrence or should we be thankful.
Your advice is greatly appreciated
Sincerely,
-SK
Dear SK: You are right to be concerned about a high fever because some important infections tend to cause high fever. For that reason, when we see such high fevers and don't find a source on examination, pediatricians run tests to look for a source and clarify whether or not the illness is viral or bacterial. These tests include such things as blood count (CBC), urine culture, throat culture, chest x-ray, and periodic reexamination to make sure nothing new becomes evident on examination.
That is the only reason to be concerned about a high fever. A temperature of 106.3 is impressive, but it will not harm the child, especially since it comes down easily in response to the Motrin. There is some slight risk of seizures with fever, but while those are frightening, they are not dangerous.
If your child is acting very well, Roseola is a very real possibility. Unfortunately, you can't know until the end of the illness which could take 4 to 5 days. As long as your child continues to act well, the only things you need to do is continue treating her fever and have her pediatrician keep a close eye on her. If she begins to be sicker then you doctor will have to be more vigorous in his medical management including such things as blood cultures, spinal tap, and intravenous antibiotics if indicated.
At 32 weeks your pregnancy is not at risk for congenital malformations from viruses. In order for your pregnancy to be at risk you would have to become quite ill yourself. The best way to avoid catching anything from your child is to observe strict hand washing after every time you handle your child.
Fever is such a common sign of childhood infection, and some children tend to run high fevers. Often these illnesses are caused by viruses. No definitive diagnosis is reached because viral studies are rarely done in this circumstance. Most viral studies results would not be available until after the patient's recovery and most viruses can't be treated with anything but supportive measures so that viral studies are generally not useful. I cannot say if your child will be prone to high fevers with illness, but there is no reason to anticipate that this illness will be recurrent. After recovery, the source of infection should no longer be in your daughter's body.
Sincerely,
Dr. Warren
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