30 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
Thank you for your time.
-GD
Dear GD: The main risk associated with ligamentous laxity is injury to the joints. Having lax ligaments does not mean your child will have a lax heart; however, ligamentous laxity is seen as part of several syndromes which have associated blood vessel disease. Specifically, both Marfan's Syndrome, and to a lesser extent Ehlers-Danlos Syndrome, have an increased risk of aortic aneurysm. There are specific criteria for diagnosing these syndromes. If your doctor does not believe your daughter has any diagnosis other than ligamentous laxity there is little cause for concern, but if he is unsure, he should have you consult a geneticist since proper diagnosis can help you anticipate medical needs.
Sincerely,
Dr. Warren
My questions are, how common is this and how long does it normally take to for a child to "grow into it" if he is going to? How will it affect his speech? How often is surgery required and under what conditions would surgery be the preferred treatment?
I hope you can help me with my questions. I'd really appreciate it.
-MS
Dear MS: Most newborns that have stridor have tracheomalacia, which is excessively soft tracheal cartilage. As a result, the trachea sucks in with each breath and narrows the airway making breathing more noisy and labored. This progressively improves with age. As to the question of having extra tissue around the larynx, without a more accurate diagnosis from your physician, I am not sure what is wrong with your son and so am unable to offer information regarding the natural course and treatment of the condition. If there is a congenital abnormality of your son's trachea such as a laryngeal web, or something causing external pressure on the trachea, you will need to consult a Pediatric ENT specialist for treatment.
Sincerely,
Dr. Warren
-PWC
Dear PWC: Shin splints is inflammation of the extensor muscles of the foot in the lower lateral leg (shin area) and inflammation of the bone lining at the muscle attachments. The symptoms are pain, swelling, and tenderness of the muscles along the side of the shin. Theses symptoms usually last 1 to 2 weeks. The main cause is overexercise by rapid walking or running. The treatment is to stop all running until it is completely healed. Running can be replaced with swimming or bicycling which uses different muscles. Ice and Ibuprofen may help to relieve some of the discomfort.
For more detailed information check the on-line Merck Manual. Push the next button at the bottom of the page to read through the entire subject.
Sincerely,
Dr. Warren
Age: 5
Weight: 48lbs
Height: 3' 10"
Urine test on 3rd day,showed minute quantities of blood.
On 5th day blood test and urine tested O.K.
On 7th day 2 penincillin injections were administered,along with chest
x-ray;blood, urine and throat culture. Results are negative.
Please advise accordingly.
-(not signed)
Dear Parent: There are many causes of persisting fever so your son will require a thorough evaluation by your pediatrician and perhaps an infectious disease specialist, rheumatologist, or gastroenterologist.
The reasons for choosing these specialists are as follows:
Since your son is having abdominal pain as a major symptom of his illness, he may need to be evaluated for inflammatory bowel disease. If his stool tests positive for blood I would definitely look in that direction, but even if the stool is negative for blood further evaluation of his intestines by x-ray studies or endoscopy may be in order if he has severe or persistent abdominal pain.
Rheumatic diseases such as Juvenile Rheumatoid Arthritis (JRA) and Lupus can cause fever long before they cause any of the other symptoms associated with these diseases. Initial blood work such as an Erythrocyte Sedimentation Rate (ESR) and an ANA may point toward these conditions.
Even though most infectious diseases that cause persistent fever might cause a change in the blood count, a normal blood count can't be taken as proof that there is no infection. A few injections of antibiotics when no diagnosis has been made are unlikely to be helpful and may even make the diagnosis more difficult. Localized bacterial infections like bone infections usually cause local pain and often cause an elevation of the white count, but not always. Lyme disease and rickettsial diseases may cause severe headache and don't cause an abnormal white count. These diseases can be tested for with blood tests. If your son's headache is very severe, a spinal tap may be needed to rule out aseptic meningitis. Mononucleosis generally affects the blood count, but may not do so early on. At this point a blood test for mononucleosis would be reasonable. Since your child has recurrent abdominal pains, a stool culture for bacteria like Salmonella, Yersinia, and Campylobacter, and a test for parasites might be helpful.
One of the most frightening things to consider is the possibility of a childhood cancer like leukemia presenting as a persistent fever. In the absence of other symptoms and normal blood work it would be unusual, but must be considered.
I have talked to you about some of the worst possibilities. It is also possible that your son will have recovered without a definitive diagnosis by the time you get this e-mail.
Sincerely,
Dr. Warren
-H
Dear H: When using toothpaste you should put very little on the brush since large amounts don't help to clean the teeth better than small amounts and the excess just gets swallowed. If you use just a tiny amount of toothpaste your daughter will not swallow significant amounts of fluoride from the toothpaste, therefore, you can resume giving the fluoride drops which gives you more accurate control over the amount of fluoride your daughter is getting.
If your daughter's mouth is clean of all food and she hasn't eaten something like garlic, I don't know why she has bad breath. You might want to have her teeth and gums checked by a pedodontist (pediatric dentist).
Sincerely,
Dr. Warren
Thank you,
-Stephanie
Dear Stephanie: Except when children are having diarrhea, bowel movements generally take effort. Any child who has bowel accidents has either been trying hard to hold it in for a while or actually pushes it out in his pants. Most children seek a private place and squat somewhat to have a bowel movement. They often resist learning to use the toilet because it is difficult for them to have a bowel movement on the bowl and they feel more comfortable sticking with the old familiar "do it in your pants" approach.
In order to succeed at bowel training your daughter, it is crucial that she not be constipated. Her stool must be soft. This may increase the number of accidents if she starts to have several bowel movements each day, but in the end, it will increase her success at having BMs in the toilet. There is no better teacher than a successful experience.
The gastrocolic reflex is most active after a big meal. When you have a full stomach, you get an urge to have a bowel movement. To take advantage of this, you should have your daughter sit on the toilet after each meal and try to defecate. Praise her if she cooperates and sits. Praise her more if she tries. And praise her even more if she succeeds. Try not to pay much attention to accidents. If she is not under a great deal of pressure to have her BMs in the toilet there is a much better chance of her cooperating and becoming comfortable with the mechanics involved in going on the toilet.
Please read my article on Potty Training.
Sincerely,
Dr. Warren
-TW
Dear TW: You may be right that the boy's grandparents spoil him. If that is a major issue, you may need to talk to them about it. But in the event that you do, you will need to offer specific rules that you want him following that you think he is not following. In the absence of guidelines, the grandparents have to use their judgment as to what is appropriate. He may not be getting into any trouble there simply because they have the time to lavish on him.
When your son responds to your directions with anger, he is expressing how he feels. All feelings are legitimate. You should not respond to his response with anger as well. He must be taught appropriate ways to express his feelings, but he should not be expected to have no feelings about being disciplined, nor should he be prevented from expressing them. When he says, "I bang you!" tell him that you understand that he is angry but you love him and you will help him to do what he has to do.
Try not to get into head to head battles with your son when he says "No!" Try to engage him in cooperating by participating in what you would like him to do or offering him choices such as, "Which toy would you like to pick up first?" When he says, "I can't" ask him why he can't. Then offer suggestions as to how he can or offer help when appropriate.
You son probably craves your attention and will take any he can get, even negative attention. Make sure you notice when he does what you want. It must make your life easier when he cooperates, but if that makes it possible for you to simply go about your business and ends the interaction with him, what's the payoff for him? Reinforce good behavior by praising it. If you can't find any to praise, look harder and praise less than perfect attempts at cooperation. Be sure to make realistic demands that your son can comply with. Try to make the situations where you ask your son's cooperation more of an interaction than a confrontation. The extra effort you put into turning discipline into positive teaching now will pay off later.
Sincerely,
Dr. Warren
Thank you.
-AC
Dear AC: When babies spit up, the spit up will contain some mucus from the membrane lining the stomach. If the contents of the stomach is partially digested, the milk will be curdled, which is why it is thick. Swallowed mucus may also be present, but generally does not upset the baby's stomach.
Suctioning will not increase your baby's congestion. To suction, place a drop or two of saline in the nostril to be suctioned. Compress the bulb and place the tip in the nostril. Pinch both nostrils closed around the tip so that there is no air leak. Slowly release the bulb so that it will draw the mucus down from up above.
Sincerely,
Dr. Warren
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