16 March 1998
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
-Mother's Friend
Dear Mother's Friend: Most babies by 4 months of age do not yet have separation anxiety even though they may be very familiar with their mother's feel, scent, breathing pattern, etc. and as a result be more easily comforted by the familiar feel of Mom. I am not sure what the dynamic is that has created such an intense bond for the baby and Mom, but it is possible that others have become tense in handling the baby and that Mom too quickly takes over in order to comfort her baby. Mom needs to try to get others involved with the baby while she is close enough to soothe the baby with her touch and her voice, but she will not be able to accomplish getting the baby fully comfortable with others in just a week.
I cannot tell your friend whether or not to cancel her business trip. She must decide for herself how important the trip is and how well she can handle it while being concerned about the welfare of her infant. If faced with her absence for a few days it is likely that the baby will adapt to her absence and begin to feed. The adaptation may be easier than she imagines because neither the baby nor the caretakers will have any other option. But it is possible the baby could be miserable for a while and that the caretakers are now too insecure about their ability to handle the baby to provide adequate comfort.
Sincerely,
Dr. Warren
-KF
Dear KF: There is no question that circumcision is a simpler procedure in the newborn period. Even after a few months of age the foreskin has become too thick for circumcision as done in the newborn period and will require sutures. Circumcision in an older child may also require general anesthesia. If the child is cooperative enough it may be done with local anesthesia. There are many who feel that the newborn circumcision should be done with local anesthesia as well.
If you are circumcised and favor circumcision, your son may very well grow up feeling he should have been circumcised and wonder why or even regret that it wasn't done when he was younger. While he may prefer to be circumcised, he may not wish to have the procedure.
I think you should decide what your own position on circumcision is and decide based on that. If you oppose circumcision and don't have it done, your son could still opt to have it done when he is older, but he is less likely to feel the need for it if you don't favor it. To help you decide look at the following web sites:
Information For Parents About Circumcision at http://www.cirp.org/CIRP/pages/parents/. This article includes a lot of information about circumcision including care of the uncircumcised penis. Information is presented to help parents decide about whether or not to have their newborn son circumcised. The intent of the writer is clearly to discourage circumcision, which may be appropriate since there is very little medical reason to circumcise. The presentation may have an unpleasant tone for those parents whose sons are circumcised.
Sincerely,
Dr. Warren
-Beti
Dear Beti: One of the hardest subject to deal with by e-mail is rashes. I've discovered with my own patients that the parents' descriptions don't always match what I see, and the correct diagnosis of a rash requires seeing it. One has to think of hives if a rash is red, blotchy, and comes and goes. Big hives have welts, but small ones may not. Generally hives itch. Hives are allergic in origin. Blotches may sometimes come and go in response to overheating, or leaning on or touching a part of the skin.
Milk allergy can certainly cause hives, but most infants who have difficulty with milk have difficulty digesting the lactose. This form of sensitivity is not allergy. If a child is truly allergic to milk, he would be allergic to the sugar or protein in it. The percentage of fat would not make a difference. A child who isn't allergic to 1% milk won't be allergic to whole milk..
Unfortunately this does not answer your basic question as to what the rash is. If it persists, you will need to see your son's pediatrician.
Sincerely,
Dr. Warren
-EL
Dear EL: A conversion reaction is a form of hysteria where psychiatric problems cause physical symptoms such as paralysis or an inability to speak. Conversion reactions were much more common in the previous century partly because the patient must believe that his symptoms are real physical symptoms and the general public is too medically sophisticated these days to find most conversion reactions believable.
I would hope that the diagnosis was based on reasonable psychiatric evidence that a conversion reaction occurred and not just on the basis of a lack of physical cause. Conversion reactions typically involve psychological conflict, so for example, the person who is unable to deal with what she might say could lose her ability to speak.
In the absence of psychological conflict consistent with a conversion reaction there are other equally plausible explanations to consider which include medication reaction, and, if the hospitalization was particularly traumatic, post-traumatic stress disorder.
Sincerely,
Dr. Warren
-Ms. W
Respected Doctor: I want to know whether I should continue using fluoride drops to my 18-months old. She was recommended to have two drops daily before she had-Ms. W
Dear Ms. W: I received two incomplete e-mail messages from you. I will attempt to answer based on what I believe you to be asking..
If your daughter's weight is in the 25th percentile she is in the low average range. You should not be thinking she is "just in the 25th percentile" as if that implies something wrong. The normal range extends from the 5th percentile to the 95th percentile with weight usually being related to height. Taller children weigh more. Height can be affected by many factors, but the main factor is genetic.
I do have a concern in that you say your daughter hasn't gained weight in the last two months, but unless that is a continuing pattern, that may mean nothing at all. You can best understand its significance by reviewing her complete weight chart with your pediatrician. Don't forget to see what her height is doing as well, because you can only get a full understanding of your child's growth pattern by looking at weight and height together.
It is not unusual for children to have a decreased growth rate and decreased appetite starting sometime in the second year of life. When children have a decreased need for food it becomes important to make sure that most of the food they eat is nutritious. Concentrate on the type of food you offer and not on the amount she eats. Avoid pressuring your daughter to eat. As long as you provide good food regularly she will be nourished. Check my article "Nutrition Without Tears".
Fluoride drops are useful to prevent cavities; however excess fluoride is as bad for the teeth as no fluoride. The current recommended dose for children 6 months to 2 years of age is 0.25 mg. per day as long as they are not receiving additional fluoride in their drinking water. I prefer to give this using a preparation that is 0.5 mg/ml rather than having parents count drops. Since I don't know what formulation you are giving I can't comment on her dosage. The recommended dose increases with age and should be continued until 14 years of age.
If I have misunderstood your e-mail and not answered your concerns in answering your incomplete messages, please get back to me.
Sincerely,
Dr. Warren
-KC
Dear KC: Even though the pox of chicken pox have live virus in them chicken pox don't spread. They break out. They come out all over the body over a course of 3 to 5 days which may create an impression of spread, but one pock does not develop from another. In a mild case of chicken pox a child may have only a few pox. The more pox, the sicker the child. It sounds like your daughter has a mild case and is nearing the end of her illness.
Sincerely,
Dr. Warren
Could she have fractured or sprained it? Should I observe it for a while, or is it best to bring her to the hospital? What can I do to help it heal better?
-Worried Mummy
Dear Worried Mummy : A loud cracking noise followed by a refusal to use an arm and apparent pain in the arm sounds ominous. Your baby could have just dislocated something, but she could also have fractured her arm or her collar bone. Bring your baby to a doctor. She is in pain and needs medical attention, even if nothing is broken.
Sincerely,
Dr. Warren
My left testicle seems to be the same size as the right, however, it feels as if there are tubes (or something) in the scrotum as well. They feel as they have fallen down from somewhere my scrotum and suddenly seem quite prominant. These 'tubes' do seem to be connected in some way to the testicle by not growing off it (as if a cancer).
It doesn't give me pain but feels quite disgusting touch. These tubes sort of hang down in the scrotum. My right testicle is normal.
Do you know what the problem is? Am I in any danger?
Your advice would be much appreciated.
-R
Dear R: It sounds like you're describing a varicocoele. A varicocoele is varicose veins (swollen veins) around the testicle. They occur most commonly on the left. They are generally described as feeling like a bag of worms. Varicocoeles are not dangerous. Large varicocoeles can cause discomfort and interfere with normal growth of the testicle. The major problem with varicocoeles is that, by increasing the temperature around the testicle, they can interfere with sperm production. The testicles function best at a temperature lower than body temperature which is why they were designed to hang outside the body. Decreased sperm production means that it may be harder to have a baby. A varicocoele does not affect hormone production by the testicles. Men who have varicocoeles are just as masculine as men who don't. Men with varicocoeles have no problem having erections or having intercourse, but they may have trouble having children.
Years ago varicocoeles were left untreated until a man had fertility problems, but we now recognize that fertility problems are not always completely reversible if you wait to repair a varicocoele. If your testicles are equal in size, there is less risk of a problem, but you should have it checked by a doctor. You may need to have your sperm count checked to determine if there is a need for repair.
The surgery to repair a varicocoele involves a small incision in the groin so the veins can be tied off. It is not serious or major surgery. You may not need a repair, but if you do, it wouldn't be urgent. So relax. Don't worry. But make an appointment to see your doctor.
Sincerely,
Dr. Warren
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