29 September 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
-LMH
Dear LMH: Children have inborn personalities. Some features of personality are inherited, so it is likely that your son exhibits personality traits which he inherited from you. There are wide variations in personality traits from person to person and child to child. It is easy to see how the child who is clingy and slow to accept change has a harder time than the outgoing child who adapts easily to change, but it is important to recognize this as a lifelong personality trait rather than a form of psychiatric maladjustment. This trait has its survival advantages. Cautious people may not have the same kind of fun as their less cautious counterparts, but they are also less likely to have their enjoyment end in tragedy.
At your child's young, tender age, he needs an opportunity to come to trust the world in a safe, structured environment. For him, adventure and new experiences aren't the answer. He needs an opportunity for social interaction in a familiar setting. He should have a play arrangement that consistently has the same people and the same structure where new people and new activities are introduced gradually so that he doesn't become overwhelmed. In that kind of setting, he might even succeed in helping a new child join the group. He needs a lot of positive experience in the kind of setting I have described before he will be ready to take on the world, and even then he will need new things introduced in manageable chunks.
As he gets older, and more verbal, it will help for him to talk about his concerns. He must do the talking and you the listening. Never reassure a child by telling him his concerns are silly or unfounded. A few experiences like that result in a child who is unwilling to share his concerns. Instead, a child who is concerned about a social situation (or other situation) should be helped to think through the situations he is worried about and come up with strategies that he could use to deal with the "what ifs."
Sincerely,
Dr. Warren
Thanks, and I love your site.
-MCA
Dear MCA: Under the circumstances, it is likely that you both have conjunctivitis (pink eye) and treatment with the neomycin ointment is appropriate, as long as you are not sensitive or allergic to the medication. You can use cool compresses to help with swelling of the eyelids. If there isn't a good response to medication within a day or two, or there is associated fever or pain, you should see a physician.
The best way to prevent the spread of conjunctivitis is to wash your hands a lot, especially after touching your eye. Even if you dab your eyes with a tissue you will get germs on your hands. You might want to consider using paper towels to dry your hands and your face until the infection is out of your house. Additionally, since you don't have hospital sinks with foot pedals, you will probably want to turn your faucets on and off with your paper towel or wipe the faucet with antiseptic after each use.
Sincerely,
Dr. Warren
-JP
Dear JP: I cannot fully answer your question, but let me explain. In researching your question I looked for medical articles about the safety of creatine. I didn't find any. That means I didn't find any study indicating there was anything unsafe about creatine, but neither was there one establishing its safety, and most especially, I didn't find anything addressing the issue of safety in teens.
Creatine is marketed as a nutritional supplement rather than as a drug. The FDA rules for nutritional supplements are much less stringent than for medications. That means there is much less study of safety and effectiveness required for nutritional supplements then for medications to be out on the market. Nutritional supplements are a very big business in the US. There is a lot of profit to be made and the hyped advertising stays just barely within the requirements of law regarding false claims.
The questions you should consider are. Why do you need to take creatine? Are your expectations for the benefit of creatine realistic or inflated? Do you know the appropriate amount for a person your size? More isn't always better. Something that's safe at a recommended dose could be toxic at higher doses.
I hope this information is useful to you.
Sincerely,
Dr. Warren
I actually have some questions which I wanted to ask you ...
My baby girl is 8 months old but born 9 weeks premature. She weighs
about 6.5kg.
1) Last week I left my baby on the bed and she rolled over and fell onto
the wooden floor (my bed is about 2 and a half feet high). Although she
had no bumps or bruises or any obvious pains I'm worried about whether
this incident could cause any damage eg. psycological problems or any
head injuries. What signs should I look out for?
I did bring her to a doctor a few days later but they said there was no
need to do any x-ray ... how can I be sure there is no hairline
fracture?
2) When my baby was 3 months old she had a hernia. The surgeon operated on it to fix it up. She said that the hernia was most likely caused by the fallopian tube falling through the stomach muscles. Since the hernia was there for a few weeks before the operation, it was a bit strangulated. I am concerned whether this could cause problems for her in terms of having a baby of her own later when she grows up. Do you think there would be a problem??
3) My friend has a baby with Blood Group O. However the parents have Blood Groups A & B. How is a baby's Blood Group determined?
Thanks for your time.
-V
Dear V: 1.
Significant head injuries generally cause significant symptoms right away. The first sign of trouble is loss of consciousness or a seizure. Later signs include lethargy, vomiting, irritability, and seizures. A child who has had a head injury who doesn't exhibit any of these signs within the first few hours is unlikely to have any future problem.
The concerns about head injuries revolve around direct injuries to the brain, or bleeding inside the head which results in increasing pressure on the brain. A skull fracture generally occurs with an injury that would be forceful enough to potentially cause a problem, but in reality, except for a depressed fracture which pushes bone fragments toward the brain, there is nothing done to treat the fracture. The real issue revolves around the head injury and not whether there might be an undiagnosed skull fracture. The other time when skull fracture would be of special significance would be a basal skull fracture with leakage of spinal fluid from the nose or ears where there is a risk of meningitis. Generally, the area around a fracture, even a linear fracture, is swollen, so a fracture without any bumps is unlikely.
One can never fully predict the possibility of long-term consequences from head injuries, but then, at 8 months, there's not much you can predict about your child's future. From your description of the fall and your doctor's finding no injury, I wouldn't worry.
2. Any significant strangulation of the ovary from a hernia would have caused your daughter extreme pain and vomiting, and if the ovary suffered such damage it would have had to be removed at the time of the hernia surgery. In addition, the ovary is a paired organ, so your daughter should have another ovary that wasn't affected by the hernia. No one can guarantee your daughter's fertility, but from what you told me, there is no reason to anticipate a problem.
3. 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
-TE
Dear TE: The introduction of table food is not a nutritional issue. Table food does not offer nutrients that differ from pureed food with the exception that raw vegetables provide more vitamins and minerals than cooked whether pureed or not. Whether or not a baby has teeth has no bearing on the introduction of table food since the first teeth are not chewing teeth. Table food needs to be introduced, because at some point, that's what people live on. The timing of table food introduction is a developmental issue. Between 8 months and 1 year most babies can handle some solid food because their swallowing mechanism has matured to the point that they can swallow particles without gagging. At that point they have no molars for chewing, so they cannot generally handle tough foods, but they can handle soft items that they can chew with their gums.
If a child gags on even small particles, he isn't ready for table food. Some children aren't ready even at one year, but that is no cause for concern. The first foods to offer should be soft finger-food items like a banana cut into small pieces. Finger-foods are little items a baby can put into his own mouth one at a time. Babies who can handle that are generally ready for small pieces of cheese, other ripe and soft fruit without skin, and pastas. If your baby can handle Zwiebacks (which crumble easily into large pieces, so I always recommend caution when introducing them, i.e., staying with the child while he enjoys it) she can probably handle Cheerios one at a time, or on a spoon softened in milk.
When introducing table food or stage 3 food, be careful about putting a spoonful into a baby's mouth. The child who can handle one piece of food to chew may not be able to handle a mouthful.
My children always enjoyed the vegetables and pasta in soup. Those are usually quite soft and easy to handle. If you use a canned soup, just remember it has a high salt content, so don't resort to it for every meal.
Sincerely,
Dr. Warren
-C
Dear C: There is no evidence that sugar causes hyperactivity. In a study done on hyperactive kids, when they were given sugar, their mothers believed that they were more hyperactive, but when the experiment was repeated using independent observers and placebos so that the parents didn't know if their children were receiving sugar or the placebo, there was no correlation between sugar intake and activity level.
Some 3-1/2 year olds are more active and have more difficulty sitting still than others. At 3-1/2, difficulty sitting still may be normal, but even a 3-1/2 year old can be hyperactive. To know if your son is more active than most children his age, you would need the opinion of someone who routinely deals with children that age such as a nursery school teacher.
Most children are potty trained by 3-1/2. Children may fall outside the normal range for a variety of reasons. Being outside the normal range does NOT necessarily mean there is something wrong with the child, but it does mean that there is an increased RISK that there is something wrong. Knowing when he does something in his diaper is necessary for training. Knowing when he has to do something is even more essential. But the first goal of training has to be getting the child to sit on the potty with regularity. Staying clean and dry is a late result. Please read my article on Potty Training.
Sincerely,
Dr. Warren
-MQ
Dear MQ: Second cases of chicken pox can be more severe than the primary case because the second person has a greater exposure. That generalization does not result in escalating severity without limits. If your daughter's severe case resulted from exposure to a large amount of virus, your son's exposure may be no greater than hers was. Your nursing will continue to provide some immunity, but not as much as when you first started nursing. That immunity may not prevent your son from getting chicken pox, but it can lessen the severity of his illness. Nine months is an unpleasant age to have chicken pox, but a nine month old is at no greater risk for complications than an older child.
Sincerely,
Dr. Warren
Recently, I have noticed excessive itching in my right ear. A type of deep itch that you really can't scratch. It's getting worse too! Is it possible that I am a host to some of my cat's ear mites? If so, what types of treatments are available? Thank you for your time. Your insight is much appreciated.
-SP
Dear SP: I never heard of ear mites until my son had a cat. Most mites are species specific, which means that a mite that lives on one species does not live on another. For example, the human mite, scabies, does not live on other animals and can't be spread to humans by other animals. To the best of my knowledge, human beings do not get any kind of ear mite. You must look for another cause for your itch.
Sincerely,
Dr. Warren
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