13 October 1997

1. Crying at Daycare, Whining
2. Surprise Delivery
3. Shuddering Infant
4. Constipation & Potty Training
5. Immunizations
6. Allergies & Ear Infections
7. Baby Stops Crying When I Stand with Her but Cries When I Sit!
8. Scarlet Fever vs Rheumatic Fever
9. Disclaimer

• Read Questions & Answers in Another Column

Crying at Daycare, Whining

-T

Dear T: It sounds like your daughter has separation anxiety. She is not crying because she is unhappy about where she is. She is unhappy about your departure. I think the same thing would happen no matter how small the daycare facility was or what kinds of activities they provided. It is likely that changing her daycare arrangement would only aggravate the current situation since she likes her provider and is happy there.

If your daughter is happy when she reads rather than participating with other children, that should not be a problem. If your daughter is very intelligent, she may face the problem that many bright children face, namely, that intellectually they belong with older children, but emotionally they aren't ready to be with older children. They feel like square pegs in round holes, but at that age, they can't understand why. Perhaps your provider could see if there is any consistency to the pattern of which activities she joins and which she avoids. That might help you to understand where her problem lies and work out a strategy to help. But, let me emphasize that, unless it's a matter of discipline and controlling the daycare setting, it isn't necessary for your daughter to participate in every activity.

Whining is an annoying noise that some children just come upon naturally because it expresses their feelings. The problem is that some children begin to use it all the time, perhaps to some extent, because it always get attention. To eliminate the problem, when you give her something she has whined for, encourage her to ask for it without whining, but don't make her getting what she wants contingent on not whining. Gently show her how she could say what she wants without whining. Keep it pleasant. Don't let whining influence your response to her. Try to give what you would give, refuse what you would refuse, and enforce what you would enforce, without regard to whether or not your daughter whines. When your daughter says something without whining, don't take it for granted. Be sure to point out how pleased you are when she speaks and asks without whining.

Sincerely,
Dr. Warren

-K

Dear K: I am not aware of a special term for an unexpected delivery. In order for a woman to be pregnant and carry the baby to delivery without knowing she is pregnant, several conditions must apply.

1. The pregnant lady must be overweight enough for the pregnancy not to show. The more uterine growth and amniotic fluid there is, the more overweight the lady must be for it not to be evident.

2. The pregnant lady must have irregular enough menses to not notice the absent periods, or she must experience cyclic spotting during the pregnancy so that she thinks she is menstruating (This does occur).

3. The pregnant lady must be oblivious to the babies movements or generally have significant enough intestinal activity that she thinks the fetal movement is intestinal activity.

4. Even with all these conditions present, it would help for there to be enough psychological denial so that the lady ignores any clue that might help her realize she is pregnant.

Sincerely,
Dr. Warren

This happened once or twice a day in the past. Lately, in the last week, we have noticed she does it 5 to 10 times a day. We are trying to monitor when it happens, and so far it seems to occur predominantly after feeding.

She is breast fed and has cereal, vegetables and fruit three times a day as well. At 6 months, we were told she had not grown (weight, height or circumference of head) since she was four months. In the last two and one half weeks since that 6 month visit, she has grown by 1 pound 3 ounces (15 pounds six ounces from 14 pounds 3 ounces) and in length as well. Her head has increased by one half centimeter. Her birth weight was 8 pounds 14 ounces.

The doctor does not know what this is, but does not feel it is anything to worry about. He has ordered an EEG just for certainty.

Have you heard of anything like this, or recognize this condition?

Thanks.

-Worried in Manitoba

Dear Worried in Manitoba: The most common situation in which I have heard parents describe their infant as shivering/shuddering is when the baby urinates. This is fairly common and no cause for concern. It is extremely difficult by e-mail to be sure I'm not missing something in interpreting the information given to me, but even if your daughter's "chill" occurs in response to something other than urination, I don't think it is a cause for concern.

Sincerely,
Dr. Warren

-JD

Dear JD: Three year olds may speak English, but they don't speak logic. No matter how much you tell her that holding her poop in will make it harder and hurt more when she finally goes, she only knows that it hurts when she goes. If she could, she would never poop, and then she'd avoid the pain (an example of 3 year old logic). Stool withholding, unfortunately aggravates constipation because the longer stool sits in the rectum the harder it gets. And constipation is the absolute enemy of bowel training.

You should, of course, continue to provide the opportunity for your daughter to have bowel movements in the toilet, but since she is having such difficulty, it is unlikely that she will jump at the opportunity. Therefore, I think she must know that even though you'd like her to poop on the potty, you will give her a diaper any time she needs it to poop. You must keep the situation as free of pressure as possible, but continue to cheerfully offer her the chance to go in the potty.

In the meanwhile you should work with your pediatrician to help regulate your daughter's bowels. If she has become, as I suspect, a stool withholder, she will need a lubricant to make it harder for her to hold stool in, and easier to let it out. This can be accomplished with 2 teaspoons to 2 tablespoons (sometimes more) of mineral oil by mouth each night. Prunes or prune juice or figs might help. A bulk former with mild stimulant action like Senokot might also help. Avoid constipating foods like white rice and bananas.

Sincerely,
Dr. Warren

We are writing from India.

Thanks and regards.

-AD

Dear AD: All infants should be fully immunized against diphtheria, tetanus, and pertussis (whooping cough) - DTP. They should also be fully immunized against polio with either the live, oral vaccine (OPV also known as Sabin) or the inactivated vaccine (IPV also known as Salk). HIB stands for Hemophilus influenza group B which is a major cause of bacterial meningitis in infants. It is an important vaccine whose use has caused a dramatic decrease in the number of cases of meningitis in infants. In places where measles is highly prevalent infants should receive a measles vaccine at 9 months; however this provides only temporary immunity. Routine immunization for measles should be given with MMR (measles, mumps, rubella) vaccine to all infants between 12 and 15 months even if they received measles vaccine before 1 year of age. Hepatitis B vaccine has become routine in the United States during infancy to protect against Hepatitis B which is spread through blood, secretions, and sexual contact. In areas where Hepatitis A is prevalent there is a Hepatitis A vaccine which can provide immunity for up to 10 years. Hepatitis A is the kind of hepatitis that can be spread through contaminated food and drink.

Sincerely,
Dr. Warren

Since he's been born, my son "snorted" alot and snores at night. Could there be a link between this sinus congestion and his ear infections? If so, how could I treat them?

Thank you so much for taking time to read this letter.

-MF

Dear MF: Both ear infections and sinus problems can result from head congestion. Head congestion can be caused by colds or allergies. It can be aggravated by enlarged adenoids. The ENT surgeon who is putting in the tubes can tell you if your son has enlarged adenoids. If you think your son has allergies on the basis of seasonal variation and apparent response on exposure to certain allergens you might want to consult an allergist. Infants who have had allergies since early infancy may have allergy to their food. Both milk and soy can cause allergic reactions which may contribute to ear infections.

Sincerely,
Dr. Warren

-(no name)

Dear Grandparent: Even though you believe that there is no difference between the way you hold your 6 month old granddaughter when you sit versus when you stand, she, no doubt, feels the difference. In the standing position we are prone to sway ever so slightly, a movement which is soothing to infants. Our grip on the child is tighter and closer to our body. It just feels different. I have never heard of an infant who prefers it when someone sits. Perhaps those parents don't feel a need to mention it. But in my experience, most children are easier to calm when holding them in a standing position. If you're finding it tiring, you might try a rocking chair.

Sincerely,
Dr. Warren

Mr. C

Dear Mr. C: Both scarlet fever and rheumatic fever are caused by beta hemolytic Streptococcus group A. Scarlet fever occurs when the strain of strep causing the infection (generally strep throat), is producing erythrogenic toxin. This toxin causes a red, sandpapery rash on the body which is most intense in the groin and under the arms. The face is red but not sandpapery, and the area surrounding the lips is pale. Scarlet fever is essentially strep throat with a rash. It occurs during the active strep infection. Years ago, erythrogenic toxin used to be stronger and made kids sicker. We are beginning to see an upswing in the virulence of group A strep strains around the world so that we may again see children with Scarlet Fever becoming much sicker than simply strep throat. The treatment for Scarlet Fever, just like for strep, is penicillin, or erythromycin for penicillin allergic patients.

Rheumatic fever is a complication of strep throat and may occur as a complication of Scarlet fever. Rheumatic fever occurs AFTER the strep throat, usually 1 to 5 weeks after strep throat. Treatment of the strep throat with penicillin can prevent rheumatic fever. Usually the first signs of rheumatic fever are fever and arthritis (a painful, red, tender, swollen joint). Rheumatic fever can also result in carditis (inflammation of the heart) which might not be evident until the patient develops symptoms of heart failure such as difficulty breathing or enlargement of the liver. On examination the physician may find a murmur from damage to the heart valves. The damage to heart valves may be severe and permanent, requiring corrective heart surgery at a future date. Children may also develop chorea (a movement disorder) anywhere from 2 to 6 months after a strep infection.

Sincerely,
Dr. Warren

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