27 October 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
-Mr. & Mrs. N
Dear Mr. & Mrs. N: Rashes are always difficult by e-mail, but your description sounds very much like hives. Hives are raised, generally itchy, white welts on a red background. They may come and go quickly with new ones popping out and old ones disappearing. Hives are caused by an allergic reaction and are best treated with an antihistamine like Benadryl.
Hives are not contagious, but they can be seen as part of some virus infections. Children can have allergic reactions to infectious agents just like they can to foods. The particular infection your children had may have been prone to cause hives, or, since the boys are brothers with genetically similar immune systems, they may both be prone to react with hives to this particular virus.
Since I didn't examine your children, I cannot say that they don't need antibiotics, but I wouldn't come to that conclusion on the basis of hives. Of course, since I didn't see the children, I can't be sure they have hives either.
Chicken pox does not behave like this.
Sincerely,
Dr. Warren
-JP
Dear JP: Since your son stays in his own bed and only disturbs you infrequently, from a disciplinary and training point of view, you've done all you can. In order to help your son fall asleep, you might need to find some bedtime rituals that help him get into the right frame of mind, such as a bedtime story or a bath. Make sure he is not overstimulated before bed by any games, overstimulating stories or TV shows.
Even though you feel your son is overtired during the day, his midday nap may be contributing to the problem. By sleeping during the day, he is wide awake at night. In order for your son to develop a normal sleep rhythm, he may need to shorten or eliminate his midday nap.
Sincerely,
Dr. Warren
-SV
Dear SV: The first thing a pediatrician does when he tries to determine if there is a problem with a child's nutrition is look at the child's growth pattern. If a child is growing and gaining weight adequately, and the food the child is eating is nutritious, then the amount is of no consequence. In order to grow and gain properly a child must be eating enough. As an infant's growth rate slows down (which happens naturally since the most rapid growth occurs during the first six months) his food intake may decrease. Some children take much less formula once they start on solids. And older children have more of an interest in what's going on around them. Since your granddaughter seems happy and is healthy according to her pediatrician, there seems no reason to worry.
All babies cry sometimes. If there has been a sudden and significant increase in the crying, your granddaughter should be evaluated by her pediatrician. There is no reason to assume the medicine is the problem. She could just as easily be crying because of symptoms the medicine aims at relieving.
All medicines have side effects. Propulsid may cause headache, diarrhea, abdominal pain, constipation, dyspepsia. Zantac may cause headache, constipation, diarrhea, nausea, abdominal pain. Colace may cause a bitter taste, throat irritation, nausea. None of the medications should be discontinued without discussing it with your granddaughter's doctor. As to whether or not your granddaughter still needs the medication, if there is a question about that, she should be reevaluated by her gastroenterologist.
Sincerely,
Dr. Warren
-Charles
Dear Charles: All babies scream, some more than others. Most babies have a fussy period which is usually between 6 PM and 10 PM, but sometimes later. During the fussy period they are difficult to comfort. The fussy period can be differentiated form other causes for crying in that it comes regularly during the day, around the same time each day. Fussy periods are part of how the central nervous system matures and adapts to the outside world. These generally disappear by 4 months.
Pulling the legs up and down is part of an infants crying behavior when the crying is intense. It is not a sign of gas pains or the need for a bowel movement. The crying behavior of infants does look somewhat like the infant is straining, but unless it regularly results in a bowel movement which results in cessation of crying, there is no basis for the assumption that the crying is related to bowel movements.
Normal infant bowel movements are generally yellow to greenish brown with a somewhat seedy appearance. The stool of a nursing baby should be soft to almost loose. If the stool is firm, it suggests some degree of constipation. Nursing babies often have bowel movements after each feeding, but after a few weeks, these may become as infrequent as every few days. As long as the stool remains soft and does not cause the baby any distress, this is not a problem.
Staying away from spicy foods and gassy foods when nursing can be very important. But did you know that if a nursing mom drinks too much cow's milk it can give the baby gas pains? There is a wealth of information for nursing moms on the Web. One of the premier places on the Web for breastfeeding information is the La Leche League International home page at http://www.lalecheleague.org/. For information about how mom's diet can effect the baby check http://www.parentsplace.com/expert/lactation/diet/.
Is your situation normal? I've given you some information to help you decide. Since all babies scream, it may be normal, but since uncomfortable babies scream, the difference between normal an a problem may be just a matter of degree. If you think your baby is unusually uncomfortable, you need to have her checked by her pediatrician to be sure everything is okay.
Whether or not your situation is the norm or indicative of a problem is, of course, the main issue in helping you cope, but it isn't the only one. You need to recognize that there are big differences in babies' personalities and need for sleep. Some newborns sleep as much as 22 hours a day and are placid. Some sleep as little as 12 hours a day and cry a lot and are hard to comfort. Even if you entered parenthood with realistic ideas instead of romantic notions, 6 weeks of dealing with a "high needs" baby can be quite draining. If that is your situation, at this point, you and your wife might benefit from a little break from the baby - just a few hours to relax knowing that someone else will take care of the baby's cries. It can make a big difference to come back to the same situation refreshed, especially if you know you will take periodic refreshment breaks.
Sincerely,
Dr. Warren
-LR
Dear LR: Weakness could mean so many things. In fact, the patient may mean many things when using the term weakness. Weakness could refer to fatigue, or actually decreased muscle strength. A feeling of faintness could be described as weakness. If one is standing or playing hard for a long time feeling a need to sit down is perfectly normal. But if a person goes into a shower feeling perfectly well, it should not result in a need to sit down before the shower is finished. On the other hand, if it is extremely hot in the shower, some people may become overwhelmed by the steam and heat.
If, in general, your daughter is able to participate in physical activity and by weakness she simply means she feels a need to sit down, you probably don't need to be concerned; however, weakness is an unusual complaint in a child, and if she hasn't recently had a complete check up, it might be a good idea to have her checked and have you doctor clarify just what she means by her complaint.
Sincerely,
Dr. Warren
Also, do babies ever cry so hard that they stop breathing? This may sound silly but when I put him in his crib to sleep (he has slept with my husband and I since birth) he cries so hard that his face turns red and I think he has stopped breathing so of course I give in and let him reattach to pacify. I enjoy your Q&As. Thanks for your helpful service.
-KP
Dear KP: Some babies are extremely picky about things like pacifiers. There are a few things you can try. First, allow the baby to draw the pacifier in the same way he does with your breast. Stimulate the corner of his mouth or his lower lip with the nipple so that he roots toward it. At first he will explore it with his tongue. During this exploration his tongue thrusts may push the pacifier out. This does not mean he is rejecting it. Rejection would result in his turning his head away and maybe even crying. After exploring the pacifier with his tongue he will begin to suck it lightly and finally draw it in. For this to happen, you must hold the pacifier to keep it from falling out of his mouth when he explores it. Even after he draws the pacifier in his tongue movements are apt to push it out on occasion. Once he is older he will hold onto it with his mouth or his hand, but at this point you must hold him and his pacifier in order for him to learn to use it. You may need to try different pacifiers to find a nipple he likes. As a last resort, you can let him suck on your finger (as long as you've washed it) in order to avoid using your breast as a pacifier. Babies can have breath-holding spells from crying hard. When this happens, no sound comes out. If a child holds his breath long enough, he may turn blue and pass out. Once he passes out, he will no longer be holding his breath so he will start to breathe again. This can be very frightening, but it is not dangerous. Sometimes a little spray of water or a puff of cool air on the face can stop a breath-holding spell. If your infant is screaming loudly and bright red, he is not holding his breath, and he will not stop breathing from his crying.
Sincerely,
Dr. Warren
Thanks!
-RU
Dear RU: The first question is, does your son have allergies? In a 5 month old, allergies to formula are much more common than inhalant allergies. If your son is nursing, this doesn't apply, but if your son eats formula, he could have nasal congestion from milk allergy. This would be even more likely if he had other allergic manifestations such as eczema. If this is a possibility, putting him on a hypoallergenic formula such as Alimentum or Nutramigen for a few weeks might make a difference. If his symptoms improve on a hypoallergenic formula, then he should stay on it.
Cough at night may just be a result of nasal drip if your son has allergies or a cold, but if he has severe and persistent coughing he should be checked to see if he is wheezing since coughing may be a symptom of asthma. Asthma may also result from allergies.
If the air is exceedingly dry, that may be irritating to the nasal membrane. Not only is the vaporizer helpful, but you can also use room humidifiers in your whole house to increase the moisture in the air. In addition, normal saline (salt water) drops in the nose can help to keep the membrane moist.
If these suggestions do not provide an answer for you, you will need to decide if your son's symptoms are severe enough to warrant a visit to the pediatrician.
Sincerely,
Dr. Warren
-K
Dear K: Rashes which come and go quickly are generally the result of increased blood flow to the skin. All people have increased blood flow to the skin after physical activity because the body conducts excess heat out through the skin. In some people with sensitive skin this results in a red rash which disappears as the skin cools. No intervention is necessary.
Much less commonly, some people develop hives after physical activity. These are raised, itchy welts on a red base. They come and go during the duration of the rash. Hives are generally allergic in origin. In some instances the combination of exercise and exposure to something to which a person is allergic, can result in hives. So, for example, there have been instances where a person developed hives from shrimp, but only if he had exercised prior to eating the shrimp. If your son has hives it may help to take an antihistamine before activity, but this may make him drowsy, unless your doctor prescribes a non-sedating antihistamine. An allergy evaluation may help to determine what is causing the hives.
If you are not sure what the rash is, you should make an appointment with your son's doctor and be prepared to have him run up and down the block in front of the doctor's office to provoke the rash so that the doctor can observe it.
Sincerely,
Dr. Warren
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