13 April 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,
a desperate, diapered-out mom
Dear Desperate Diapered-Out Mom: Your child's fear of the toilet may be related to the expectation that he should use it. Even the slightest suggestion may seem to him like pressure to do something he feels not ready for. Or his fear of the toilet may be unrelated to the training process. Either way, he needs to be desensitized. He should be encouraged to explore the potty and toilet with no pressure to sit. If this does not cause him any distress work on having him come into the bathroom regularly just to get him used to scheduling bathroom breaks and praise him for any cooperation. Once this is established encourage him to sit on it, pants up, lid down, with no pressure to use the facilities. Praise him for any cooperation. Once he has established a willingness to do this regularly, lift the lid and follow the same procedure. Next get the pants down. After that take off the diaper or underpants. Stay at each step long enough for it to become established without fear or pressure. Praise cooperation. Ignore failures. Once sitting on the toilet without pants and the lid up is firmly established start encouraging using the toilet, but try to avoid pressure. Any time your child does something in the toilet praise him. Clean up accidents quickly and matter-of-factly with no fuss. After using a toilet is established work on decreasing accidents by encouraging regular use and cooperation when your child appears to need to go.
If you haven't read my article on Potty Training look for it at http://www.mindspring.com/~drwarren/potty.htm. Good luck!
Sincerely,
Dr. Warren
- Thanks,
Todd
Dear Todd: Chewing gum poses a choking risk to young children, so it isn't a good idea to offer it to a two year old. But once it is swallowed, it poses no risk at all. There is no cause for you to be concerned.
Sincerely,
Dr. Warren
- Thank you,
Andrew
Dear Andrew: Temper tantrums are a way that children express a combination of anger and frustration. They become more common in the second year of life because children don't have the verbal ability to express how they feel and at the same time they are beginning to relate to the world as independent people separate and distinct from their parents. The little baby who could be satisfied by being held and having his basic needs met has turned into a person with much more complex needs and desires. No person is born with a willingness to be controlled by another, and yet, for their safety and in order to teach our children how to get along in the real world, we must control them.
Most brief tantrums should be ignored. The absolute rule for dealing with tantrums is to never give children what they want to end a tantrum or to avoid a tantrum because that encourages them to throw tantrums in order to get their way. On the other hand, our aim is not to frustrate our children to teach them the realities of life. The realities of life will make themselves known soon enough. Children should be loved, protected, and when possible, kept happy. To do this and avoid tantrums without letting the children be in control, parents must use their wit and intelligence to distract and redirect children from problem situations. Situations that regularly cause tantrums should be reevaluated by Mom and Dad to see what can be changed to avoid the tantrums and still teach the child his parents' rules. That means having realistic expectations for what rules a child can follow. You don't leave a gun where a two year old can reach it with the idea that you'll teach him to stay away from it. Neither should your classic record collection be accessible to him if he goes after it. Keeping temptation from your youngster's path until he is old enough to deal with a particular situation will avoid a lot of aggravation for you and your child. Providing him with a safe means to satisfy his curiosity and interact with his environment under your control will help avoid conflict. For example, show him the stove when it's not hot. Let him handle your prized (unbreakable) item with you and show him what it's really about.
Sincerely,
Dr. Warren
On Sunday he wasn't much better, with the exception of the sleeping. He did better there. I called his gastro and told him. He told me that he wanted to do the gastric emptying test this week and talked more about the fundo. Needless to say, I was quite nervous, and why so drastic if his PH Probe came back with only slight reflux (it WAS a "good day" for him and the gastro says they swallow better with the tube in) and his endoscopy showed that his esophagus is was a little red and his intestines a little "ratty".
So, I called the gen ped today. He wasn't too keen on the fundo. He said he would talk to the gastro and get back to me. I get a call from the gen ped a few hours later. He says: "<The doc> and I discussed Christopher and decided that the fundo would not help him. You see he's <the doc> a little frustrated. I asked him if it would hurt the baby to take him off the meds and he said no. So, number one, take him off of everything and number two, bring him in this week to be weighed and I will check on his developmental stuff <I asked about him not really rolling over much~he's done it about 4-6 times and doesn't sit up at all>." I said: "So is it your intention just to keep him off the meds and that's the solution? I don't understand, we have tried that many times before. Also, why is it that the meds worked great for 6 weeks and now they won't work at all, and we should just bag them??" He said: " Maybe not, but alot of times the meds no longer help and they start counteracting. Just keep Mylanta on hand for his fussy times. You see he's almost over the hump, at 8 or 9 months they get better, and he's not far from there." I said: "So, should I not schedule the motility testing?" He said: "Well, there is really no use in doing that. You see the Reglan and the Propulsid, make they system work to empty the stomach,etc...<I already knew that>"
Okay, my question to this yet again, long winded saga...Is it of your opinion that the meds just "quit" and never work again? Also, are there just kids out there that don't respond to the meds? What are you supposed to do? My older son had this too and was NO WAY near as bad as my baby. And definitely not doing the stiffening, screeching and twitching thing past 3 months or so--just vomiting....I just can't bear to see him in pain for much longer. Thank you so much again!
-Susan
Dear Susan: I don't believe that medicines just quit working, but if a baby has a severe degree of reflux, his response to medication may not be as dramatic as a baby with milder reflux. I don't think that physicians can really explain why two people with the same illness can have such a broad range of symptoms; however, if your son's esophagus is inflamed, then it is unfortunately, reasonable to expect that the reflux would cause him a greater degree of discomfort.
You have already used all the medications I am familiar with for treating reflux, and, since I am not a gastroenterologist, I do not have additional ideas, other than that you might review how you are positioning your baby for sleeping and feeding to see if there is anything in his positioning that may be contributing to the problem. Sometimes, when a patient has chronic symptoms, it is not sufficient to get a few minutes of advice on the telephone about what to do. It sounds to me like it is time to schedule a consultation with your gastroenterologist where he should explain all the test results and all your treatment options to you. If you haven't had a second opinion on the matter, you might like to consult another pediatric gastroenterologist just to be sure that there aren't any treatment or diagnostic options that have been overlooked.
Finally, you might want to see if you can talk to other parents of kids with reflux to see what experiences they have had. You might ask your gastroenterologist if he knows of a parent support group. Or you might strike up some conversations with parents in his waiting room and start your own support group. You might also look to see if there are any groups on the internet. A good place to start might be a general parent support group like Parent Soup.
Sincerely,
Dr. Warren
-SB
Dear SB: According to Cunningham's textbook of anatomy the average length of the small intestine is around 6 meters with a range of 4.5 - 9 meters. The large intestine is somewhere around 100 cm. Therefore, even a very long set of intestines wouldn't be more than 10 meters or 11 yards. That may stretch across your backyard, but not around the world.
Sincerely,
Dr. Warren
-R & D W
Dear Mr. & Mrs. W: Cerebral dysplasia is not, to the best of my knowledge, a definitive diagnosis, unless it is a term used in other countries besides the USA to refer to cerebral palsy. The term dysplasia refers to abnormal tissue development. In any event, if your daughter has not been able to walk without crutches for 14 years, it is unlikely that there is a treatment to restore the part of her brain that controls motor function. The treatment she can most benefit from is physical therapy.
If you live in the United States you might want to look up a local chapter of UCP (United Cerebral Palsy) which provides many services for disabled people. Your daughter may benefit by having an evaluation by a neurologist if she has not seen one.
Sincerely,
Dr. Warren
-Swimmer
Dear Swimmer: If swimming causes any pain it would be reasonable to stop the swimming for a while to allow complete healing of your injury. You should also stop the exercises that cause you pain; however, unless there is rapid improvement of your discomfort, you should see a doctor. You should also make sure your parents know what's going on so that they can decide if you need to see a doctor.
Sincerely,
Dr. Warren
Thank you very very much, and I also wanted to say what a help your web site is. My husband and I both work 2 jobs each (1 at home and 1 outside the home), and so it's hard to drop everything and run to the pediatrician every time I have a question (they won't answer any questions over the phone, I always have to scheule an appointment and go in). I read all of the questions and answers, even if I don't have those problems with either of my children, but now I have some ideas if something similar arises! Again, thanks!
-RS
Dear RS: Rashes are extremely difficult to diagnose without seeing them. Sometimes when I speak to a patient I can ask enough questions to have an idea what's going on, but it's even tougher by e-mail. The questions I might ask to get a better idea are:
If it is hot, a baby may develop heat rash. The rash starts as fine bumps which may be red if it is inflamed.
Allergic rashes can include hives which are red areas with welts in them. Small hives may not have welts. Hives itch and tend to come and go. Eczema is a more chronic allergic rash which is generally scaly and red.
If a child with a rash does not appear ill and the rash is not spreading or bothersome, you can always wait a few days to see if it goes away. Any rash that persists or is a problem must be seen for diagnosis and treatment.
Sincerely,
Dr. Warren
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