11 May 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
-A concerned and loving mom!
Chrystal
Dear Chrystal: All infants spit up, some more than others. If your baby's colic is better and he is gaining weight well and wetting plenty of diapers, the increased spitting may not be indicative of a problem. As infants begin to eat more, they often start to spit up more. If your son is retaining most of his feedings and seems happy, he should stay on the Nutramigen. If your son is vomiting excessively, you should contact your pediatrician.
Sincerely,
Dr. Warren
-D & H
Dear Mr. & Mrs. H: Infants and toddlers vomit much more easily than adults. Hard crying can make some children vomit. I've had a few patients who cannot be allowed to eat before they come to visit me because they will invariably vomit from screaming during the examination. Children don't start out vomiting intentionally, but they can very quickly learn to use it if they see it gets the desired response.
Your daughter no doubt vomits unintentionally from crying. But she has also learned to force herself to vomit as an end result of crying. She may not fully understand how this controls your actions, but she certainly knows you respond to it. If you wish to change the situation, you must accept the inevitability of her vomiting from crying and be prepared to deal with it without giving in to her.
This can be done several ways. First, if you don't want her in your bed, even though you will lose a number of full nights of sleep, you should go into her room frequently to calm her and get her back down without vomiting to wean her away from your bed. Second, you should have a bucket ready at her bedside so that you can pick her up and hold her over the bucket if you think she is about to vomit. Third, you should have a change of clothes and sheets ready at her bedside and necessary cleaning supplies so that if she does vomit you can clean up the mess as quickly as possible with as little fanfare as possible, and get her back into her own bed.
The same principles should be applied to daytime screaming. If she starts to scream hard, rush her into the bathroom. While all children enjoy attention, no child is likely to find being held over a toilet so enjoyable that he will purposely seek such a response.
Sincerely,
Dr. Warren
She is physically active in sports, however recently we have noticed she is experiencing muscle injuries. Is this linked to her new diet? How can we help?
We were worried about lack of protein, however everything we have read indicates protein effects mostly her bones and joints.
Thanks for your help.
-TR
Dear TR: It is perfectly possible to have a nutritious diet without vegetables or meat. Protein is certainly an essential ingredient for growth and cell repair, and meat is an excellent source of protein, but there are many other foods that provide the same quality protein as meat. Milk protein is excellent protein. Yogurt is ounce for ounce the nutritional equivalent of milk. Cottage cheese also provides good amounts of milk nutrition. Other cheeses have more fat and less protein, but still provide some of milk's nutrients. Cereal has protein and is often fortified with vitamins and minerals. If cereal is eaten with milk, the milk protein becomes part of the meal. The traditional American diet is at least 20% protein, whereas 7% of calories from protein is sufficient to prevent malnutrition.
A good selection of cereals, fruits, grains, and breads will provide all of the nutrients found in vegetables.
It is unlikely that your daughter's injuries are related to dietary deficiencies. It is more likely related to the nature of her activities. It is not true that protein effects mostly muscles and joints. It affects all tissues. However; as I previously stated, it is possible to have a nutritious diet without meat. If you are unsure whether or not your daughter's diet is adequate, why not consult a nutritionist. You may get the reassurance you need, and if there is a problem, the nutritionist will be able to design a nutritious diet for your daughter based on foods she is willing to eat.
Sincerely,
Dr. Warren
If you are familiar with this please explain a little bit more for us. We are very concernd and are looking for more information on this problem and possible procedures. We will be waiting to hear from you, and thanks in advance for any information.
- A grandma(nunnie) and mom
Michelle
Dear Michelle: The condition you describe is called "Pectus Excavatum." For most people, pectus excavatum is little more than a cosmetic issue. If the chest capacity grows adequately with the child there will be no effect on breathing capacity or heart function. Even though there may be a heart murmur related to the shape of the chest, it does not represent a heart problem. Only the most severe cases of pectus excavatum require surgery. The biggest problem regarding pectus excavatum is that parents don't like the way it looks and find it worrisome, and when the children who have pectus excavatum grow up, they may not be happy with their appearance.
Sincerely,
Dr. Warren
Dear Readers: My response to Michelle generated a bit of heated discussion. In my attempt to reassure her, I neglected to discuss the surgery which could be necessary to correct this deformity. Those who had a bad experience with Pectus Excavatum and the doctors who did not take their concerns seriously, considered my response misleading and irresponsible. Lest you take my response to Michelle as the final word on the subject, or mistake my reassurance to her to imply that surgical treatment is only cosmetic and unnecessary, please read the following two letters posted in response to my answer to Michelle.
-PR
Dear PR: Hand-Schuller-Christian Disease is one of the subcategories of Histiocytosis X. The cause of the disease is unknown. The symptoms of the disease are largely dependent on which tissues or organs are invaded by histiocytes. Even though the histiocytes are not malignant, the illness in many respects resembles leukemia or cancer. Many of the treatments used to control the disease are cancer medications. Therefore, you should consult a pediatric oncologist - a specialist in pediatric cancer. You may need to consult other specialists depending on which organs become involved with the disease.
I do not know anything about hospitals in Brazil. There are many fine hospitals in the USA. If you are contemplating coming to New York, you might want to contact Sloan Kettering Hospital, which is a world famous cancer hospital.
For more information check the rare disease database at the NORD Web site at http://www.stepstn.com/nord/rdb_sum/408.htm.
Sincerely,
Dr. Warren
Thanks so much-
-Theresa
Dear Theresa: If your son does not have diarrhea or abdominal pain from the amount of fruit he eats and has sufficient appetite for other good foods, he is not eating too much fruit. Fruit is good, healthy food. All fruits are good for you. Variety in the diet is the key to making sure all important nutrients are consumed.
Sincerely,
Dr. Warren
-JR
Dear JR: I have had very few patients who continued to have ear infections after tubes and found very little in the way of a satisfactory explanation as to why. It is certainly possible that chronic allergies may contribute to chronic congestion and may involve the ears even with tubes in place. If you feel that allergy is playing a significant role you may wish to consult an allergist. The diagnosis of food allergies can be approached by doing RAST testing (a blood test) for suspicious foods, or by eliminating suspicious foods from the diet. Elimination diets can be difficult because you may have to eliminate all the offending foods before seeing an improvement and then will have to return foods to the diet very carefully. If your child is a picky eater, keeping him nourished on an elimination diet may be difficult. In addition, unless you prepare all your own foods from scratch, you will need to read and understand food labels. For example, if milk were the suspected food you would have to eliminate all milk proteins like casein, lactalbumen, and lactoglobulin.
Normal bathing should not get water into your son's ears, however he cannot immerse his head under water. If he does, the water getting into his middle ear may result in an ear infection. Cotton is not an effective plug to keep water out of the ear. If the cotton gets wet, it will pull moisture into the ear. Silly Putty, if applied over the ear canal, can act as an effective barrier. It should not be pushed into the ear or you may have difficulty removing it.
Sincerely,
Dr. Warren
-AB
Dear AB: It is not crucial that your son eat any specific amounts of food at specific times. Generally, we start children with cereal, up to 4 tbsp. morning and evening and fruit, up to 4 tbsp. with the cereal. Then we add vegetables at lunch followed by meats with the vegetables. For more details read my article, Feeding Your Infant. The amount of formula will vary from child to child. An average 6 month old consumes 6 to 8 ounces 4 to 5 times a day. Even a hungry 6 month old shouldn't wake so many times during the night. Your child hasn't learned to put himself to sleep. There will most likely be some crying involved in teaching him, but I wouldn't describe it as "letting him cry it out." You will need to gradually decrease the amount of intervention you offer, and he must be put into his crib awake to learn to go to sleep in it. For more details read my article, Helping Your Child to Sleep Through the Night.
Sincerely,
Dr. Warren
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