23 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
Any advice that will make our son (age 2.5, weight 26 lbs.) eat? He is extremely finicky, and at his size, he can't afford to miss any calories.
We've debated punishing him for not eating, but so far he's called our bluff. We must find solution that will result in him eating.
According to our pediatrician he's healthy. But he is in the 5th percentile, and we just know he could get more food into his body. We are trying very hard.
Any secrets we're overlooking??
-Kind regards,
J & S K
Dear Mr. & Mrs. K: 26 pounds is at the low end of the normal range for a 2-1/2 year old. Unless this is a dramatic shift from your son's prior growth pattern it does not mean he is unhealthy. Many small children are extremely finicky eaters simply because their slow growth rates mean they have a small caloric need. In any event, you must remove your anxiety from your son's meals because stress at meal time will not improve his appetite nor will it get him to eat. Absolutely don't punish him. Growing up being forced to eat does not promote good eating habits. If your son has a small appetite your goal is simply to make sure that anything he does eat is nutritious. Please read my article Nutrition Without Tears. I think it will answer many of your questions and relieve your anxiety.
Sincerely,
Dr. Warren
-MD
Dear MD: Yes, a child may have a different blood type than either parent. Traits like blood type are inherited from parents on genes. For each trait, people have at least two genes (sometimes more but we don't need to complicate the picture to understand the answer to your question). One gene for each trait comes from the mother and one gene from the father. Some genes are dominant, which means if you have just one gene for that trait, you will have the trait. Some traits are recessive which means that for the trait to show up you need both genes for that trait. A and B blood types are dominant traits. O blood type is a recessive trait. If a person has two genes for A (AA) or one gene for A (AO) his blood type will be A. If a person has one gene for B (BO) or two genes for B (BB) his blood type will be B. A person can only have O blood type if he has two genes for O (OO). If two people have a child and one parent has type A (AO) and the other parent has type B (BO), their child could have A (AO) blood, B (BO) blood, AB (AB) blood, or O (OO) blood. If they had a child with AB blood that would be a different blood type than either parent, but it's easy to see that it's a mixture of the genes for their blood types. The child with type O is also a mixture of the genes from both parents since each parent contributed a gene for O blood type.
Sincerely,
Dr. Warren
-BH
Dear BH: Ulcers are not a common disorder in children. Your son should have as thorough an evaluation as possible to determine the cause of his problem and that certainly should include testing for H. pylori. If your son has not been evaluated by a pediatric gastroenterologist, I would recommend you see one.
Sincerely,
Dr. Warren
-CI
Dear CI: It is true that the temperature control center is in the hypothalamus, but I believe that you are experiencing what many mothers experience when they first put their child into daycare. It is not a coincidence that your child's frequent fevers started when he started daycare. While some of the children may not appear terribly ill, they may still be sick. Sometimes at the beginning of an illness some children may not have many symptoms, but they may still be contagious. The fact that there are a lot of children means that your child is exposed to a lot of germs. Since the environment is new for him, he may get sick more often than some of the other children. With time this should improve.
Sincerely,
Dr. Warren
The first time it happened, at 15 months, we had X-rays, etc. and nothing showed. He resumed walking two weeks after it happened.
He's twisted it again -- same foot. I think he'll be walking within a week or less, because he seems more willing to put weight on it than the first time.
I didn't know that going down a playground slide with an adult (on lap or in front between adults legs) was a highly risky activity. The second time, especially, I tried to be really careful.
Does my kid have unusually weak ankles (his dad's joints are bad) or are slides fundamentally dangerous? My friends take their toddlers down slides and they also didn't know it could be dangerous.
-Ms. G
Dear Ms. G: All playground equipment has some potential risk to it. There is nothing uniquely hazardous about a slide, especially regarding ankles. Since your son had the same kind of injury twice you need to look at how he lands on his feet and whether the shoe he is wearing contributes to his injury in any way. Since your son is quite young he may not be ready to land on the ground himself so you may need to ease him off the slide onto his feet.
Sincerely,
Dr. Warren
-TB
Dear TB: Until I received you query I had never heard of warts on the vocal cords. I did a little research and found out that human papilloma virus can cause warts in the nose, throat, and larynx. I found one article that mentioned a recurrence 44 and 47 years after surgery. I found several other articles that suggested immunologic treatment for children who have multiple recurrences. As you can see, depending on the circumstances, there is a broad range of possibilities for recurrence.
Since I only know what I just read about Laryngeal Papillomas, my best advice, should your granddaughter have recurrences, would be to ask the ENT about immunologic treatment. If he is not aware of it, ask for a referral to a pediatric immunologist or to a pediatric ENT who has experience with this problem.
Sincerely,
Dr. Warren
My 3 1/2 month old son was diagnosed with kidney reflux (in both kidneys) inutero, when he was born he was put on a phrophalatic dose of amoxicillin, when the kidney u/s came back it showed that the left kidney had gone back down to normal and the right one was ever so slightly dialated. He was taken off the antibiotic and will be seen for another u/s at one year.
When he was about 3 weeks old he started stiffening and screaming at feedings. He was eventually seen by a Pediatric GI specialist and diagnosed with Reflux. Since then he has been on eight different medicines, none of which helped for more than 4 or 5 days at a time. The current medicine Prilosec (he is on 10mg, 2 times a day), seems to be helping the most. He has just started "breaking through" this medicine last night, after being on it for seven days. Anyhow, two days after he had his Upper GI (he was about 2 months old), he awoke with a shriek that I had never heard come from him. I happened to look down at his hands and they were bright blue and cold. We called the pediatricians office and got one of the nurses (it was a Sunday), she said she wasn't concerned because he didn't spike a fever and the hands were going down. Two days later it happened again after he came out of his bath and I called the regular pediatrician, he still wasn't concerned.
It has been three weeks or so since this has happened and on Wednesday, after I took him out of his bath, not only his hands were blue, but his entire arms and they were close to the shade of black. This time it was taking even longer to go back to normal. In a panic I called the pediatrician back again, he had his nurse call back saying he wasn't concerned because it was only the outer extremities and it was probably an immaturity of his system.
I am sorry for this long winded question, but basically I am asking if this sounds right to you or if I should still be concerned. It has happened again on Thursday, also and I am questioning whether a child this old, should still be turning colors.
Thanks for your time.
-S
Dear S: In 3-1/2 months you have already been through quite a bit with your little one, so it's no surprise that you are somewhat anxious. Still, I can't help but feel that as a pediatrician I have to take what a parent tells me at face value, even if I think the parent may be anxious, and your description of cyanosis (blueness) so deep that it appears almost black sounds a bit extreme to be dismissed as normal. It sounds to me like your child needs further evaluation.
If the only part of the body to be blue is the extremities, it may be nothing serious, because generally the lips and central portions of the body would be blue as well with either a respiratory or cardiac problem. If this happens again I would ask you to take note of the color of the baby's lips and the rest of his body just in case they are blue too, but not as blue as the extremities. Since it occurred after a bath, perhaps the baby was extremely chilled.
Since your baby has reflux, it is possible that he is experiencing some respiratory problem by breathing in regurgitated material. If your child should be coughing or wheezing as part of the picture this must be considered.
My greatest concern would be that your child has a cardiac abnormality. Cardiac abnormalities that cause cyanosis may not always be evident at birth. The cyanosis of the extremities may be what caught your attention, but you would expect there to be cyanosis of the lips and a general gray tinge to the skin as well. One condition, Tetralogy of Fallot, would cause the child to appear blue, but could also be punctuated by episodes of more severe cyanosis where the baby would appear distressed and weak.
I think what you must do, even though it is difficult to be calm when you see something that frightens you, is to make careful note of all the following if it happens again:
Please let me know the outcome.
Sincerely,
Dr. Warren
Yesterday, (April 24), she was diagnosed with a second ear infection, which again followed a cold. She is now being treated with Septra (I think that's the correct spelling - a sulfa drug) and will take it for 10 days.
My concern is that we may be looking at repeated ear infections, since she is in a daycare facility 3 days a week.
At what point would the problem become chronic enough that a pediatrician would recommend ear tubes? I realize it may be premature at this point.
Also, is there anything I can do to minimize her exposure to colds or to minimize congestion and fluid build-up that often results from a cold? I have given her Pedia-Care for her 2 colds, but I'm wondering if there is any stronger over-the-counter medecine that she could take at 7 months.
One final question - Can repeated ear infections affect her ability to hear and/or her speech development?
Thank you in advance for your comments.
-TE
Dear TE: Recurrent ear infections can be a very frustrating problem. Generally tubes would be considered if medical therapy with prophylactic antibiotics were unsuccessful and middle ear fluid persisted more than 4 to 6 months. Prophylactic antibiotics should be considered in children who have persistent middle ear fluid and recurrent infections. While you may be heading in that direction, you are not at that point.
Decongestants are helpful in treating cold symptoms which can contribute to middle ear problems, but there is no evidence that such symptom relief can prevent middle ear fluid or infection. Decongestants have been shown to be ineffective for treating middle ear fluid.
As of this point there is no clear proof that middle ear problems interfere with speech and language development, but in my experience, it appears that children who have persistent middle ear problems during the time they are developing speech do have some problems. Middle ear fluid and infection does interfere with hearing, but the effect is temporary rather than long term. When the ears are clear the hearing returns to normal except in the most extreme situations.
For a complete discussion, see my article on middle ear infections.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
