1 September 1997

1. Sinusitis
2. Pink Eye
3. What is the Fifth Disease?
4. Childhood Obesity
5. How Serious is Bronchiolitis?
6. Severe Allergic Reaction
7. Young Male Embarrassed by Swollen Nipples
8. When to Worry About a Vomiting Infant
9. Disclaimer

• Read Questions & Answers in Another Column

• Feature Article: Child Safety: Newborns and Young Infants: Even before your baby is born you have to start planning for his safety. With just a little advanced planning it's simple to keep your newborn or infant safe.

Sinusitis

-K

Dear K: Sinusitis, an infection in the sinuses, usually develops from chronic nasal congestion. Symptoms might include a sensation of pressure, fullness, or pain, over the sinuses in the middle of the forehead, next to the nose, and under the eyes. The discomfort may be aggravated by bending over. The area over the sinuses may also be tender to touch. Pus drainage from the nose can also suggest sinusitis. This should not be confused with the discolored mucus which is found intermittently in the nose as the mucus thickens and dries. Sinusitis may also cause fever and headache.

Treatment requires taking a decongestant and an antibiotic. Some cases of sinusitis may require treatment for three or more weeks.

Sincerely,
Dr. Warren

-DB

Dear DB: It sounds like you have conjunctivitis, which is also known as pink eye. It can be treated with an antibiotic drop. You should call your doctor.

Sincerely,
Dr. Warren

Thank you .

-Miss JL

Dear Miss JL: Fifth Disease is caused by parvovirus. It got its name by being the fifth infectious childhood illness with a similar rash to be described in the medical literature. The other name for it is Erythema Infectiosum. Usually the only symptoms are the rash. The illness tends to be more severe in adults than children and may be associated with some low grade fever, headache, cold symptoms, or intestinal symptoms.

The rash starts with bright red cheeks, the so called "slapped cheek" appearance. It then progresses to the trunk and/or the part of the arms and legs close to the body. At first the rash appears red, but clear areas quickly develop giving the rash on the body its characteristic lacy appearance. The rash may last up to 6 weeks. During that time the rash may disappear only to recur with exercise or exposure to sunlight. The period of contagion starts before the rash appears, and since the rash can persist well beyond the period of infectivity, there is no purpose in excluding children form school.

Complications are rare. There may be some arthritic symptoms. Parvovirus can also cause a hemolytic anemia (a break down of red blood cells). If a pregnant woman catches Fifth Disease it could cause hemolytic anemia in the fetus which can result in miscarriage.

Sincerely,
Dr. Warren

Thanking you in advance

Dear Very Concerned: Children, as well as adults, become overweight a little bit at a time. They don't have to pig out to do it. If a person burns less calories than he eats either because he is less active or eats just a little extra (which may still be less than someone else his size), over time it can add up to a large number of extra pounds. Consume just 100 calories more per day than your body needs (the equivalent of 1 glass of juice or 2 small plain cookies) and you gain 10 pounds in 1 year. Stick with the same excess for 5 years and you've got 50 pounds to lose.

Glandular problems are rarely the basis for childhood weight problems. Most children with glandular problems are short, whereas, most obese children are tall. If there is any doubt, your pediatrician can check your daughter's thyroid levels and other glands if there is any suspicion.

At 12 years of age your daughter's first menstruation is not necessarily late. It depends how far along her pubertal development is. For girls, the first sign of puberty is breast development. On average, menstruation doesn't start until 2 years later. Many girls don't start puberty until 12 or 13. For them it would be perfectly normal to not start menstruating until 14 or 15. Many children slim down during the growth spurt of adolescence, but you can't depend on that. When children grow their appetites increase. If they choose all high calorie foods to satisfy their hunger and/or are couch potatoes, they will continue to gain excess weight.

I have written an article on childhood obesity which can be found on the Web at http://www.mindspring.com/~drwarren/obesity.htm. Both you and your daughter should read it.

Sincerely,
Dr. Warren

Many thanks.

-JG

Dear JG: Bronchiolitis is a respiratory infection caused by Respiratory Syncitial Virus (RSV). The severity of the illness is not strictly related to the age of the infant. The infection causes wheezing. If the wheezing is severe the affected infant can have significant respiratory distress, in which case, it would be a serious illness.

The primary treatment for bronchiolitis is treatment for wheezing. Infants with mild wheezing can be treated with albuterol syrup. Moderate wheezing can be treated at home with albuterol inhalation by nebulizer. Severe wheezing requires hospitalization for monitoring and treatment. Critically ill infants with bronchiolitis require treatment at a tertiary care institution such as a teaching hospital where they can administer an aerosol of an antiviral agent called Ribavirin. Mist such as a vaporizer or mist tent is also somewhat helpful.

Sincerely,
Dr. Warren

They did run a special test (which they said must be run withing the first two hours of onset) and sent the tests to a special lab to possibly diagnose the "allergen." I asked if this may not be an allergy at all (since he has done nothing than he ordinarilly does or eats). Could this possibly be a seizure? His EKG showed no abnormalities, and they refuse to run a CAT scan.

He has seen two dermatologists who merely said to use an Epi-Pen and monitor his BP; but still offered no cause. What can we do? What could a possible cause be? Have you ever experienced or read of anything similar? We would appreciate any answers or places to turn to.

-Sincerely,
VG

Dear VG: By your description it sounds like your son is having a severe allergic reaction. Your description doesn't sound anything like a seizure. A CAT scan would not be useful in his evaluation. While it is possible that the test run when he had the last episode may provide information regarding what he is allergic to, it may not. There are allergy tests that can be run when a person is not having a reaction. Therefore I would recommend that you consult an Allergist.

In the meanwhile, you might want to consider keeping a diary of what your son eats, drinks, and does, to see if there is any common thread which might give a clue as to the source of the allergy. People often assume, incorrectly, that an allergic reaction has to be to something unusual or new. Allergic reactions actually require prior exposure to sensitize an individual. You cannot be allergic to something you've never been exposed to before, and you can become allergic to something that has been part of your life for years.

Sincerely,
Dr. Warren

Thank you Doctor!

-D

Dear D: You didn't say how old you are in your e-mail, but by the nature of the problem you are having and the fact that you referred to yourself as a young male, I am assuming that you are somewhere in the range of 13 to 16 years old. If I am wrong, my advice may not apply to you and you should write back to me with more details.

The problem you are asking about is called adolescent gynecomastia, and it is fairly common. You probably have no idea how many other boys have it because they are just as embarrassed as you are, so they keep it a secret. When a boy enters puberty, his body changes a lot. His testicles (the medical word for balls) start producing a lot of hormones that are responsible for the enlargement of his penis and the development of pubic hair and body hair. The main hormone that the testicles produce is testosterone, the male hormone. The testicles also produce estrogen, the female hormone. Early in puberty, when the testosterone levels are still low, the estrogen may cause some breast tissue to develop. The amount of breast tissue is usually small and it shrinks away.

Most teens are extremely self conscious about their bodies. Their bodies have changed so much in such a short time that they are often unsure what is normal, and they think everyone notices what they are worrying about. I'm certain that the swelling of your breasts is much more noticeable to you than it would be to anyone else. In fact, normal men don't have completely flat nipples. The breast tissue or nipples may stick out in someone who is muscular and has large pectoral muscles, and in someone who is overweight, and some people just have more prominent nipples.

My advice would be to wear the clothing that you feel comfortable in and not self conscious in, and to be patient because the breast swelling should go away soon. If you think that the amount of breast swelling is very large, you should talk to your parents and have them bring you to your doctor who can reassure you or tell you if something else should be done. If the breast swelling is very large or you feel that you can't live with it until it goes away, you can talk to your parents and your doctor about seeing a plastic surgeon to reduce the size of the breasts, but I wouldn't rush into surgery if your doctor finds that you have typical adolescent gynecomastia that should go away by itself.

Sincerely,
Dr. Warren

Other than the vomiting, he appears to be fine except that he's more irritable and his appetite is not as good as usual. He does not have any fever or diarrhea.

We have just moved to China and medical assistance is not conveniently available. I would much appreciate your advice on whether anything is seriously wrong with him and whether it would be advisable to take him to the hospital.

Thank you.

-Mrs. JT

Dear Ms. T: It is, of course, difficult to tell how sick a patient is without seeing them, so if your instinct tells you that your child is very sick, you should have him seen by a physician. Vomiting may be seen as part of many illness, and need not be serious. There are two aspects to the problem of vomiting that will determine how concerned you should be.

1. When children vomit there is a risk of dehydration. If a child is unable to retain any fluids they can become dehydrated quickly. If a child's vomiting is intermittent and he retains a significant amount of what he drinks the risk is minimal. If a child has difficulty retaining fluids, in order to prevent dehydration you should start feeding with small amounts of an electrolyte solution such as Pedialyte. The amount should be increased gradually. The child should not be fed food or milk until the vomiting has resolved for at least 4 to 6 hours and he is retaining significant amounts of clear fluids. If the child cannot retain any clear fluids, he needs immediate medical attention.
2. If the child is not becoming dehydrated, the seriousness of the vomiting depends on what is causing the child to vomit. Children often vomit in response to many infectious illnesses. If the child develops high fever or has other worrisome symptoms, medical attention is warranted for those symptoms. Diarrhea and vomiting usually means an intestinal virus. The need to be seen would be dependent on whether the child can retain adequate fluids. Severe abdominal pain could be a sign of a serious intestinal problem. Since a young infant can't tell where he hurts, any indication that he is in severe pain such as crying fits or moaning would require evaluation.

From your brief description it sounds like your son should be fine as long as he is able to retain adequate fluids.

Sincerely,
Dr. Warren

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