22 December 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
Thank You
-SC
Dear SC: The mothers who told you they were advised that the tubes should come out of their children's ears were probably referring to tubes that were still through the drum. The tube is made of an inert material which should not be irritating to the ear canal. It will not hurt the growth of his ear as long as it is simply lying in the canal and is not through the drum. On the other hand, if the tube is lying freely in the canal, it should not be difficult to remove. If the drum is intact, it could be removed by irrigating. Irrigation is generally not painful, although some young children are frightened by it and are not inclined to cooperate. If the tube is lying freely in the canal it will eventually come out on its own.
Sincerely,
Dr. Warren
-(unsigned)
Dear Sir: If your wife had chicken pox 2 weeks ago she should no longer be contagious regardless of whether or not she took medication. Once all the pox have scabbed and no new ones come out the illness is over and no longer contagious. This takes about 1 week from the time a person starts to break out with pox. The incubation period for chicken pox is 12 to 21 days. That means that you can come down with them as long as 21 days from the last day that your wife was contagious. Therefore, there is still a chance you could develop chicken pox.
Sincerely,
Dr. Warren
I don't know if its something that I may be feeding her, a germ on the toilet or in the tub (even though we do keep them clean), or what it could possibly be.
She says it is itchy and sometimes she doesn't want to go potty because it hurts. It looks red, not raw it but a little bluish. I have described her symptoms and taken her in so many times, to three different doctors, and I cannot seem to find an answer anywhere. Can you please help me shed some light on this matter? At this point, I am so worried as to why its not going away. I'm at my wits end.
-JM
Dear JM: Rashes are one of the most difficult subjects to discuss without seeing the rash. The Nystatin and the Lotrimin both work for yeast infections. If your daughter responded to treatment with these but had a recurrence and a doctor thought she had a yeast infection she might benefit from treatment with an antifungal medication taken by mouth such as Diflucan. Before she can be treated properly, you need a correct diagnosis. Therefore, I would suggest you see a dermatologist.
Sincerely,
Dr. Warren
Thanx in advance.
-SH
Dear SH: Chicken pox can cause mild scarring which is not entirely preventable. The natural course of chicken pox is for red bumps to form which blister. The blister fluid turns cloudy, the blister opens and the sore crust, and finally it scabs. All the blisters must go through these stages. The rupturing of the blisters does not increase the likelihood of scarring. Obviously, scratching at a sore and gouging the skin can cause scarring. Any marks which are left will be fairly prominent right after you recover. Their color will be deep pink and may take up to a year to fade. In addition, they will not tan this year. Therefore, if you try to assess your degree of scarring right after the illness is over you will severely overestimate.
Sincerely,
Dr. Warren
Thank you for your suggestions.
-B
Dear B: Most bruises occur over bony prominences such as the vertebrae and on the shins because children are always banging into them. If a child develops deep purple bruises with minor or no injury scattered on the body, this could indicate a bleeding disorder and require evaluation. As to the child with the marks over the vertebrae, it depends on the age, how active the child is, and if there is any possible explanation for the bruises. An older child who is very active may not remember how he got minor bruises. An infant should certainly not have bruises over the spine.
Sincerely,
Dr. Warren
Thanks so much for your help. I hope to hear from you soon.
-KM
Dear KM: Up to this point, your child's growth cannot be classified as failure to thrive. At 29 inches her height is in the 90th percentile so she has maintained her growth rate. We often see children eat and grow in spurts so any decision to do further evaluation should be based on a careful review of the growth curve. At 16.3 pounds your daughter's weight is between the 3rd and 10th percentile, which is certainly slim for a child whose height is in the 90th percentile, but it is in the normal range. If your child has always been slim, this may be perfectly normal for her.
I cannot say what the behavior you describe when she is eating means and would suggest that she have a feeding in the doctor's office so that he can observe the problem. It may be time to reevaluate the reflux.
I am not convinced that appetite stimulants play any role in the management of child nutrition. I'm a firm believer in respecting a child's appetite. If the food that's being offered is nutritious children should be adequately nourished on what they eat. The fact that she eats baby food in daycare and not at home is unusual and may suggest that anxiety at home about her intake is resulting in pressure on her to eat, and she is responding by resisting. As difficult as it is to remain calm when our children's behavior worries us, it is essential to remain calm about feeding. No child has ever learned good eating habits by being pushed to eat.
As long as your daughter's growth curve shows adequate growth there is no concern about it becoming too late. There is not a specific length of time to let anything go on. Your doctor must monitor her height and weight and if he finds a significant fall off he will have to recommend further evaluation and action.
Sincerely,
Dr. Warren
Thanks for your time.
-AM
Dear AM: Some children are more prone to mouth sores than others. These are known as canker sores or aphthae. Trauma to the mouth can contribute to the development of canker sores. This can happen from injury with a tooth brush or from rubbing against the wires of braces.
If your son tends to get outbreaks of multiple sores at the same time that take a long time to heal, you might want to have him checked by his pediatrician when he has them. In particular, it would be a good idea to have his white blood cell count checked to make sure he isn't neutropenic (low neutrophil count - a kind of white blood cell). Children who are neutropenic do get a lot of mouth sores. Treatment depends on the diagnosis.
Sincerely,
Dr. Warren
I will appreciate and look forward to your reply. Thank you.
-Grandma
Dear Grandma: I can understand your distress, but you must remember that you are not privy to all the details of why William's mother feels he needs to be disciplined this way. I would hope that his mother will not ruin Christmas since it is such a magic time of year for children. But keep in mind that the threat of no gifts for children who misbehave has always been part of the Christmas mystique. Children have been told through the ages that Santa is watching to see if they are "naughty or nice" and that bad children get a lump of coal in their stockings instead of a gift. The risk is to not state the threat so strongly that a parent has no choice but to follow through or lose credibility. Unless a child is truly able to understand and misbehaves badly in spite of his understanding, it is best for a child not to pay such a high price as missing a rare and special event. Punishments can always be meted out in another way on another day as long as the child is aware that his reprieve is only the result of the special occasion and punishments will not be routinely postponed.
Mom may still make the best of this situation by telling William what he must do to make amends, and then in the spirit of charity and teaching her child how to behave, she should accept his efforts even if they are less than perfect. And while we're talking about charity, if Mom thinks William has too much and doesn't appreciate what he has, why not help him participate in the joy of giving by visiting a shelter or poor community and giving some gifts to those who have less.
As to the effect this will have on William, a lot more depends on how William's mother treats him all year than what happens on Christmas. Children are resilient, and William will get over this before you do. The loss of one Christmas will not damage him and there will be other Christmases. On the other hand, if William's mother is emotionally abusive to him, he will carry scars for the rest of his life that even wonderful Christmases will never erase. Children are our future. They are truly God's most precious gift. They need discipline in the form of a strong but gentle guiding hand that is nurturing and loving.
Happy Holidays!
Sincerely,
Dr. Warren
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