18 August 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
-F
Dear F: A gallbladder attack is caused by stones in the gallbladder. If a stone obstructs the duct it results in spasms of the gall bladder which causes nausea and severe abdominal pain just below the ribs in the middle of the upper abdomen. Repeated episodes can result in inflammation of the gallbladder and infection which might cause fever as well. Symptoms tend to be worse after a fatty meal since bile production is increased to help digest the fat.
The most frequently used test to look for gallstones is an ultrasound study. Some stones may show up on a plain x-ray. A cholecystogram is an x-ray study done with a special dye that is concentrated in the gallbladder. A blood count and liver function tests (chemistries) may be useful blood tests to aid in the diagnosis.
The definitive treatment is surgical removal of the gallbladder. Acute infection requires antibiotic treatment. Lithotripsy, shockwaves or soundwaves, can be used to break the stones without surgery. Gallbladder symptoms can be managed conservatively with a low fat diet and pain medication, but long-term management of persistent symptoms eventually requires surgery.
Sincerely,
Dr. Warren
Please Help!
Thank you,
-CQ
Dear CQ: I think you hit the nail on the head when you asked if you may have created a problem by always trying to get another ounce or two into your son each feeding. Since your pediatrician reassures you that he's growing and gaining well, why not give your son an opportunity to determine how much he eats based on his appetite. At first he may take a little less, but once he gets used to the pressure free method of eating, if he's hungry, he'll take more as long as you make it available. He may very well be making up the difference in his solid feedings.
If your son likes the cup, by all means offer it to him. But to avoid the same mistake, when he shows no interest in it, don't coax him to take it.
Sincerely,
Dr. Warren
-AB
Dear AB: There are 3 web sites I recommend looking at. The first is an article I wrote about infants and sleep at http://www.mindspring.com/~drwarren/sleep.htm. The next 2 sites are about devices that are commercially available to help babies sleep. These sites are for the Sleep Tight device whose web site is (no longer available) and for Nature's Cradle whose web address is (no longer available) .
Considering that your son's sleeping problems date back to just 3 weeks of age, he may need some special intervention like one of the devices I mentioned above. In general, if you're going to let an infant cry, you can't set an arbitrary time limit for yourself or you teach the infant to cry for at least that amount of time. At 3 months I think your son is a bit young to have to cry 2 or more hours to go to sleep, but read my article to help prepare yourself for the future and look at the two infant sleep aids I mentioned.
Let me know how you proceed or if you have more questions.
Sincerely,
Dr. Warren
Thanks for your attention,
-O
Dear O: Any color of brown, yellow, or green, is normal for stool. Stool is often green when the children take an iron supplement. The normal stool for a nursing baby is often almost watery. Since your infant is growing well, I would not worry.
Sincerely,
Dr. Warren
The article was in Parents Magazine and quotes Barbara Dennison, M.D. and Columbia University.
As far as the growth problems, its pretty ambiguous as it also refers to a lack of a balanced diet.
The suggestion is to serve the children 5 and under one cup of juice per day and the balance of fluids with calcium rich milk and water.
This sounds fine but our son is still sensitive to all Dairy products.
WHAT JUICES ARE SPECIFICALLY BAD AND WHAT JUICES ARE GOOD?
Looking forward to your suggestions.
-DP
Dear DP: Children who drink a large amount of juice are at risk for obesity because of the calories, but so are children who drink large amounts of milk. Children who consume a lot of juice may develop diarrhea from it. Since juice does not provide all the nutrients that milk provides, a child who drinks a lot of juice INSTEAD of milk may not be as well nourished, but that depends on the rest of the child's diet.
If Dr. Dennison is actually quoting figures from a study, the statistical association of increased risk for obesity and nutritional problems above a certain amount of juice does not mean that every child who consumes more than that arbitrary number develops a problem. Since there are so many other variables in diet, the end result is highly dependent on what the rest of the diet provides.
If your child is sensitive to dairy products he may tolerate a soy milk or a low lactose milk, but if his diet has sufficient calcium and protein and your doctor is satisfied with his growth, I don't think you need to change his diet based on the specific amount of juice recommended by Dr. Dennison.
Juices that are 100% fruit juice are the best. Juices that have added sweeteners such as corn syrup and artificial flavors are undesirable. Read labels on juice drinks and punch since they are often not pure juice.
Sincerely,
Dr. Warren
Prior to accepting this child, we would like to know what problems could arise from a premature baby, and what symptoms to look for.
Thank-you very much,
-Ms. L
Dear Ms. L: Any medical conditions resulting from prematurity, such as asthma from bronchopulmonary dysplasia, should be evident already. The more subtle problems such as learning difficulties may not be evident. Since the child's motor development is normal you might want to inquire about his language development. A 2 year old should be saying a lot of words and saying some 2 or 3 word phrases. He should be using language to communicate. If there are delays in language development it could be a result of inadequate stimulation rather than prematurity.
Since life carries few guarantees, I'd say if the child is healthy to go for it. Plenty of 3 pounders become healthy adults. I was 4 lb. 14 oz. at birth and that was almost 49 years ago when the techniques for dealing with premies weren't as advanced as they are today.
Sincerely,
Dr. Warren
-SB
Dear SB: Children who tend to freckle begin to develop a progressive increase in freckling with sun exposure. Most of us are very cautious about direct sun exposure for our infants, but as they get older and want to play outside, their sun exposure increases, and so do the freckles. Freckles are harmless, but children who freckle easily, especially children with red hair, are more susceptible to skin damage from sun and should wear appropriate skin protection. Melanoma, skin cancer, is not really seen in childhood, but a lifetime of sun exposure does increase the risk.
Moles are common in childhood and are not a cause for alarm. Most will never become cancerous, and those that will are not likely to get there during childhood. Since most melanomas start from moles, removing suspicious moles can help to prevent melanoma. Suspicious moles include rapidly growing or changing moles, moles with uneven coloration or multiple colors, moles with irregular or indistinct borders, moles that ulcerate or bleed, and moles that lose their hair if they had hair or develop hair if they didn't have hair. Halo nevi, moles that have a light colored ring or halo around them, tend to alarm parents, but they are harmless.
Sincerely,
Dr. Warren
Some helpful information:
Greg weighs 20lbs and is about 27inches tall (a bit on the chunky
side.)
I eagerly await your advice!
Thank you for your time,
-J
Dear J: Infants spit up whereas toddlers generally do not because as the child grows and spends more time upright, the rotation of the stomach changes making the valve between the stomach and the esophagus competent so that stomach contents don't just come up. Spitting up is normal during infancy.
If you notice certain foods increase the amount of spitting it is reasonable to avoid them as much as possible, but if your child is thriving (healthy, happy, growing normally), it is not essential. Formula intolerance may sometimes cause spitting without causing diarrhea. Usually such infants have other signs of intolerance such as gas pains.
While keeping him still after a feeding may be helpful, it may thwart his motor development if you restrict his movement for excessive time periods. Since spitting will be aggravated by gas bubbles it is important to pay attention to burping after feeding. Since bubbles rise to the top the best position for the baby is to be kept upright as long as possible after feeding, but avoid having him sit hunched over which will put pressure on his stomach.
When a baby is gaining weight well it usually means that the amount of spitting is not excessive and therefore not a cause for worry, except for the mess it makes. If the spitting is a new symptom or has increased significantly there may be a need for further evaluation. Symptoms that might suggest a need for evaluation for more clinically significant gastroesophageal reflux are as follows:
Sincerely,
Dr. Warren
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