8 June 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
-AT
Dear AT: From your description of your daughter's symptoms, I doubt that it is an emergency. Brief pains that occur where you describe are most likely muscular or skeletal in origin. Based on the location you would have to consider ulcer and hiatus hernia, but it is unlikely that either would cause pains that are so brief and both would probably cause nausea. It is on this basis that your doctor has probably concluded that her complaint is not emergent.
Since the complaint is probably not emergent I would hate to see you have to go to an emergency room. Perhaps I am a bit naive about pediatric care in other parts of the country (I'm in practice in Long Island, NY) but I can't imagine a patient of mine being willing to wait more than a day or two to be seen, no less three weeks. Is there a shortage of pediatricians in your area? While I don't think your daughter's condition is likely to be an emergency, I don't see why anybody should have to wait so long to receive care or evaluation for a condition that concerns them.
Sincerely,
Dr. Warren
-JB
Dear JB: Lead testing should be done routinely in children around 1 year of age in any area where the houses are old enough to have lead paint. For more information about lead poisoning and it's prevention point your web browser at the California Department of Health Services' on-line pamphlets about preventing childhood lead poisoning brought to you by ParentsPlace.Com. It is also routine to test for anemia at this age because children this young may have iron deficiency anemia due to diet.
The biggest risk of not testing is that your child has a lead level that requires intervention. Children with lead levels between 10 and 20 micrograms may not have any symptoms; however they should be followed in case it goes higher and their environment should be investigated for a source of lead. Children with levels between 20 and 40 micrograms may also be asymptomatic, but they should be treated.
I take blood from small children all the time. We have the child sit in the parent's lap. The parent holds the child in his lap with the child's legs between his own legs. He holds the child's body up against him with his arm crossing over the child's arm. My assistant hold's the arm from which I draw the blood.
Sincerely,
Dr. Warren
About two weeks ago (in anticipation of returning to work and receiving more than 3 hours of sleep at a time) I started to add approx. 1 tablespoon of rice cereal to her night-time formula (Isomil). During the day, Katie eats approximately 5 oz. of formula every three hours with occasional sips of water in between feedings. Katie did not have these kinds of movements before I added the cereal. Could it be the cereal that's causing the runny bowel movements? I assume that the cereal binds her at night (ergo the firm stool in the morning). Or could there be something else wrong? (my family has a history of irritable bowel syndrome and other stomach ailments). My family doctor mentioned to stop adding the cereal if the diarrhea continues. I'm just afraid that it could be something else.
Thank you for your help.
-BJ
Dear BJ: If your infant has no more than the three BMs per day that you describe, no cramps, no vomiting, and a good appetite, it sounds like there's nothing to worry about. Normal infants have one to six BMs per day which are generally soft and almost loose. If your infant's stools always seemed formed, they may have been a little too firm.
Cereal rarely causes diarrhea. If anything, it's usually binding. If the stool has become somewhat firmer from the cereal, after the baby has the firm BM, the BMs that follow may get progressively softer over the course of the day.
I personally don't believe that cereal provides any nutritional benefits over formula or that it makes infants sleep through the night better. Infants sleep through the night when they are mature enough to do so. The purpose of introducing cereal is to introduce spoon feeding as a step toward an adult diet. I never recommend adding cereal to the bottle unless there is a medical reason to add it and rarely recommend starting spoon feeding before 4 months. For more information on infant feeding you might want to check my article, Feeding Your Infant.
In summary, it doesn't sound like there's any cause for alarm about your baby's stool pattern, but neither is there any compelling reason to continue the cereal. Whenever you introduce a food, if you suspect it might be causing a problem, discontinue it and try it again at a later date.
Sincerely,
Dr. Warren
-MR
Dear MR: There are very many causes of recurrent fevers in children. The specialists you may need to see could include an infectious disease specialist, a rheumatologist, and a hematologist/oncologist. The fever pattern you describe does not fit any one specific illness since there are no infections or inflammatory diseases that have a periodicity of 4 weeks.
The apparent pattern may be coincidental and these fevers may just represent ordinary childhood virus infections. If your child has been treated with antibiotics each time, it may be that he has a cyclic neutropenia. The white blood cell count drops approximately every three weeks with cyclic neutropenia leaving the patient susceptible to bacterial infection. Antibiotics may then result in recovery, but unless the white count is checked each time, the neutropenia may not be discovered. Patients with neutropenia tend to have skin infections and mouth sores.
Urinary tract infections may be recurrent, but don't have a predictable cycle since the recurrences are sporadic. Diagnosis depends on obtaining a urine culture.
Rheumatic diseases like JRA may cause prolonged or recurrent fever but would not follow a 4 week cycle. The specific frequency you mention is not likely with cancers or blood diseases other than cyclic neutropenia.
Most causes of recurrent or persistent fever eventually cause some other symptoms that point toward the organ system involved. Specific symptoms would be the best guide to further investigation.
Sincerely,
Dr. Warren
Thanks.
-LY
Dear LY: Most infections, including colds, are not transmitted through breast milk. The baby can catch your cold from being handled by you so you should wash your hands and wear a surgical mask before handling him in order to prevent spread of the cold. These measures should prevent the cold from spreading to your baby. Unless you have somebody else to take care of your baby, the risk that the baby could catch your cold is the same whether you nurse or bottle feed him. Therefore, you should continue nursing.
Sincerely,
Dr. Warren
So my question is three-fold (finally): is a head that is in a percentile group of 20 points or so something to NORMALLY worry about; from the few things I told you, do you think hyrdrocephalus is a possibility; finally, should I make a very conscious effort to place my daughter on her stomach so that she can strengthen her muscles necessary for development? Thank you for your advice!
Sincerely - MM
Dear MM: Hydrocephalus causes the head to enlarge progressively more rapidly than the body. If the head circumference is 20%ile points more than the body size, but still within the normal range and not growing so rapidly as to cross percentile curves, it is not an indication of hydrocephalus. Still, if the pediatrician seriously entertained hydrocephalus as a diagnosis for any reason, he should arrange for a CT scan of the baby's head since early diagnosis and treatment always results in the best outcome.
Many children at 8 months are not crawling. It is true that a child must be on his belly to crawl, but by 8 months, a child should be able to turn over if he wants to crawl. Infants should experience time on their bellies and backs, but should be placed in the crib to sleep only on their backs. Unless a baby's activity is restricted, most babies simply develop at their own pace, and since they turn over at about 4 months, it doesn't make much difference whether they start on their belly or back, as long as there is room for them to turn over if they wish.
Sincerely,
Dr. Warren
Can you please explain to me a little bit about what a fibroma is and what the cause might be? The plastic surgeon says it will be sent to the laboratory for analysis when it is removed. Could it be cancerous ?
Thank-you from,
-GG
Dear GG: A fibroma is a benign tumor of connective tissue. Some people are prone to develop fibromas. In a genetic condition called Von Recklinghausen's disease or neurofibromatosis, patients develop many fibromas and neurofibromas. The reasons why a person may develop an occasional tumor while another person does not remain somewhat of a mystery. While we know that certain environmental conditions may increase the risk of tumors and cancers, we cannot generally say why a person has a particular tumor unless they have a family history, specific illness associated with tumors, or a known exposure to carcinogens.
Often physicians can be fairly certain what a lump is by it's clinical appearance, but all tissue removed must be examined by a pathologist to be 100% sure what it is and whether or not it is cancerous.
Sincerely,
Dr. Warren
Thanks,
-TH
Dear TH: Diabetes causes thirst, increased urination, and weight loss. If these symptoms are ignored, it will progress to cause abdominal pain and vomiting.
Sincerely,
Dr. Warren
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