22 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
As he is getting older this is becoming more and more frequent. I assume because is he getting more active with age. I can't let him play anymore when it's hot out and I give him plenty of fluids.
He has gone for many tests, such as, EEG, MRI, Genetic testing, Sweat Test, which all came back normal. He has seen two neuroligists who don't know why this is happening. They ruled out migraine but that was all.
He does have broken capillaries on his body on his lower back, face (cheek area), legs, and upper back/neck area. I have mentioned this to the doctors but they don't say much about them.
Is there any information on what my son is experiencing, and how I might be able to help him. I appreciate anything you could tell me.
Thank you,
-Tisha
Dear Tisha: It is certainly reasonable to have a neurological evaluation for a child who has unstable temperature control since temperature control is regulated by the hypothalamus; however, if the problem were thermoregulation, you would expect to see low temperatures and high temperatures with and without activity.
You describe a situation where exposure to heat or physical activity makes your son's temperature rise and remain elevated for some time. It has been well documented that the heat produced by physical activity causes normal body temperatures to rise. If you take the temperature of a healthy adult immediately after running a mile, it may be elevated to 103 or 104, however, the runner will be sweating profusely and his temperature will return to normal within minutes of stopping running. Sweating is the major mechanism by which the body lowers its temperature. This of course leads me to ask, does your son sweat?
Sweating is impaired or absent in anhidrotic ectodermal dysplasia. There are some typical aspects of appearance which can help to make the diagnosis of ectodermal dysplasia such as pointed ears, wispy hair, pegged teeth, thin dry hyperpigmented skin which often has prominent veins. The diagnosis can be confirmed by a skin biopsy.
With complicated problems that have been evaluated by many specialists, it is hard to offer a new idea without seeing the patient and reviewing all the tests done. I would be curious to know if your son's growth is normal since heat intolerance may be seen with certain glandular (endocrine) abnormalities.
Sincerely,
Dr. Warren
Twin "A" appears to be developing at a normal rate - he can grasp things, takes active interest in his surroundings and can lift his head and chest well off the ground when placed on his stomach. He does have thrombocytopenia, but this appears to be resolving on its own. He is quite colicky, but still is generally happy.
Twin "B" is not developing as fast. He cannot yet lift his head and tends to favour one side. He cannot yet reach and grasp things such as a rattle. During the third term ultrasound, dilated ventricles and enlarged kidneys were noted on his chart. He does take active interest in his environment and is very happy (smiles easily in response to his parents).
Our physician assured us the dilated ventricles are of no concern (they were only 11mm). He has been placed on antibiotics to prevent kidney infection (an ultrasound after birth did show some reflux, therefore, the antibiotics were deemed prudent until he reaches age two).
Our physician has said "don't worry" and then referred us to a developmental specialist!
Is this likely a simple case of neck strain ( I read a previous letter regarding an infant who favoured one side and could not hold its' head straight) or are we faced with a more serious situation?
-IC
Dear IC: At 4 months 75% of infants will grasp a rattle touched to their hand but less than 25% will reach for a rattle. 100% of 4 month olds will lift their heads up. Greater than 90% will lift their heads up 45 degrees, and 90% will lift their heads up 90 degrees. If I am getting an accurate picture of twin B's ability to lift his head, he has a significant motor delay. Not only is it appropriate for him to see a developmental specialist, but a pediatric neurology evaluation might be a good idea. If there was a question of ventricular enlargement (I assume you meant ventricles in the brain) on a prenatal ultrasound, and if the baby has significant developmental delays, a CT scan of the head would be appropriate.
A 4 month old who doesn't lift his head would have to have a significant neck problem for it to be a result of neck strain.
Sincerely,
Dr. Warren
I am the father of a 17 month old son. Up until about 3 months ago, he had a fairly regular sleeping pattern. Then he began to go through a head banging phase where he would pout and hit his head on the wall, floor, sofa, coffee table, etc. whenever he did not get his way. My wife and I tried to curb this harmful reaction by giving him choices and helping him to understand why we were doing certain things. We tried to pick him up and hold him and we tried to let him keep hitting his head until it hurt too much. But he would get big bruises on his forehead and keep on going. He would even bang heads with people who were holding him.
He took this pouting to his crib, and when we would put him down for a nap or to go to sleep at night, he would stand up, scream, cry, throw everything out of his crib, and then bang his head on the top of the rail of the crib. He bloodied his nose on some crib toys before we took them down. We bought a twin size bed, put up a guard rail along one side, pushed it up against a wall on the other side and he did ok. This was about two weeks ago. Then he began the entire crib phase over again. Three days ago we began putting him in a padded play pen, but last night be began the pouting phase again.
It should be noted that we try to tire him out during the day. In fact, recently he has been sleeping from 9 p.m. to 7:00 a.m. and then only taking a one hour nap at about 10:30 a.m. before he wakes up again. We have given him Baby Tylenol, Baby Orajel, and gas medicine to ease possible teething pain or gas. We check his diaper and make sure it is clean. We have even let him cry for 45 minutes before we give up and check on him. I have even tried to let him sleep with us once, but all he did was try to play (at 1:30 AM!)
So with all of this case history information, here are my questions --
- JA
Dear JA: Some aggravating childhood behaviors are often the result of a child's inability to express his frustration. Children who are upset about not getting what they want may respond by screaming, crying, vomiting, breath holding, head banging, biting, throwing tantrums, etc. These are spontaneous expressions of the child's feelings and are not done to obtain any specific response; however, children can quickly learn how to use these behaviors once they see the kind of response they get.
You need to do your best to protect your son from injury. If that means tying padding to all parts of the crib, that's what you have to do. But if banging his head is his response to not getting what he wants, giving him what he wants when he bangs his head will reinforce the behavior.
Even though your son had a regular sleep pattern in the past, he may not have learned to go to sleep in his crib if you took advantage of his sleep pattern and put him into the crib asleep or as he was falling asleep. Or as he matures and his relationship with the world changes, he may be discovering that he doesn't want to be left in his crib. Whatever the reason, he needs to learn that he will be taken out of his crib every day and put in to sleep every night. Reasonable efforts should be made to soothe him when you feel it is necessary, but he should be returned to his crib to go to sleep. Over time you should decrease your degree of intervention.
For more details, please read my article, Helping Your Child to Sleep Through the Night.
Sincerely,
Dr. Warren
Thanks !!!!
-JV
Dear JV: The job of a pediatrician is rewarding and often enjoyable, but no matter how much you know, it is never easy. Children are often too frightened to cooperate with an examination. Diagnoses are not always obvious and patients don't always respond to treatment in predictable ways. The hours are long. Emergencies can occur any time throwing you behind schedule or making it necessary to see patients after hours, even in the middle of the night. There's a ton of paper work involved in getting insurance companies to approve treatment that patients need, and each insurance company has different rules, policies, procedures, and forms to be filled out.
The thing that is the most fun about being a pediatrician is fooling around with my patients.
Sincerely,
Dr. Warren
I'm willing to consider alternative treatments to help her avoid catching so many colds, but I don't intend to use herbs as a replacement for conventional medicine and drugs.
It seems that many doctors discount anything other than mainstream medicine. Yet, my daughter seems to be caught up in an endless cycle of colds, ear infections, and more colds.
Have there been any studies on the effects of herbs on reducing the number of colds or lessening the severity of colds that are caught? I don't want to give my daughter anything not deemed safe. Conventional medicine seems to focus on treating symptoms, which is fine as far as it goes. But, I'm also looking for ways to avoid sickness. Any advice would be appreciated.
-TE
Dear TE: It is true that most physicians are not educated about alternative medicine and tend to dismiss anything that isn't mainstream medicine, but in some regards, we are required to dismiss any treatment which hasn't met a burden of proof regarding safety and effectiveness. There are probably some treatments that may help small numbers of patients which are overlooked because they don't help the majority and therefore, on a statistical basis, cannot be proved effective. I think that any physician who chooses to treat his patients in this manner risks losing his license for being a quack or being sued for malpractice for not following proven and accepted protocols. As much as our patients would like us to keep an open mind and provide them with information about all the alternatives, they still expect us to treat them with the most recent and best scientifically proven methods.
With this in mind, I hope to convince you that conventional medicine has not abandoned prevention leaving it to the herbalists. In fact, preventive medicine in the USA has been so successful that we tend to take it for granted. Have you ever wondered why this country doesn't have outbreaks of typhoid fever or plague? Physicians long ago discovered the association of typhoid with sewage contamination and plague with rats. Control measures resulting from those discoveries have prevented the spread of these diseases. There are many public health laws aimed at controlling the spread of diseases like TB, syphilis, whooping cough, etc. All these preventive measures came about with the input of physicians. It doesn't stop there. There is a major push in this country to get all our children immunized. And there has been an explosion of new vaccines over the past three years. Perhaps you don't think of safety education as a form of disease prevention, but more children die or become disabled from accidents than most diseases, and much of this is preventable by educating parents about safety issues. In pediatric offices across the country pediatricians spend part of their time telling parents about car seats, bicycle helmets, putting infants to sleep on their backs to prevent SIDS, accident prevention, and poisoning prevention.
Herbs are not new in medicine. While we conventional medicine practitioners are not inclined to mix potions of leaves and herbs to hand to our patients, our brethren in the pharmaceutical industry are searching the rain forests and the jungles for new and exotic ingredients to make new drugs. Physicians don't offer a patient a mixture containing foxglove to treat the heart because the active ingredient, digitalis, was discovered and isolated ages ago. While the prospect of mixing a few pinches of inactive natural herbs together and somehow creating a potent mixture with mysterious and magical properties sounds so enticing the reality is that when herbs work they have active ingredient with specific properties that produce the desired effect in a reproducible and scientifically provable manner.
If you're looking for a way to decrease the frequency of your child's respiratory infections, you should look to what we know about colds for answers. Upper respiratory infections are contagious illnesses that spread by exposure to infectious droplets. In order for your child to catch a cold, she has to be exposed to one. Decrease her exposure and you'll decrease her frequency of illness. That can be best accomplished by keeping her hands washed and washing your hands before you deal with her. When sick people, especially other children come into your house, do your best to keep them away from your daughter and be even more vigilant about hand washing and washing items which may have become contaminated with their germs. This especially includes telephones, doorknobs, and toys. Do not let your daughter share drinks or food with sick people. Do your best to keep yourself from catching colds and be aware that when you have one, even if you have only minor symptoms, if your daughter catches it from you it may be a major illness.
Of course, I have no objection to your looking into using herbs or any other alternative to conventional medicine as long as you choose treatments that are safe and seek appropriate medical care when your daughter has any potentially serious illness., but I know of no evidence that the immune system can be boosted or colds prevented with the use of herbs.
Sincerely,
Dr. Warren
-KAW
Dear KAW: It is possible to have a cat and a young baby, but some precautions should be taken. First, before your wife gets pregnant, you should be aware that cats can carry toxoplasmosis which can cause birth defects. If you cat is an indoor cat and your vet has determined that the cat has no parasites there may be no need for concern. Cats that are allowed out could pick up an infection any time. To avoid exposure, your wife should not handle the litter box. It may even be advisable for your wife to be tested before proceeding. She should discuss this with her obstetrician.
There are myths that cats smother infants or suck the air out of them. These myths are not true. (That's why I called them myths.) Cats are climbing animals. They love to go onto high surfaces and can easily climb into a crib or onto a changing table. If you do not want the cat in the infant's crib, you will have to position the crib away from any furniture the cat can climb onto and be sure that the cat cannot climb any surface of the crib; however, most cats can fit between the slats of the crib and can probably reach the mattress from the floor. Keeping the cat out of the infant's crib at night would probably require closing the door or preventing the cat from entering that area of the house.
Even though it is unlikely that a cat would harm or hurt an infant, as a general safety measure I would never leave an infant alone with any animal.
Sincerely,
Dr. Warren
Thanks for any advice.
-AMB
Dear AMB: A rash localized only around the anus generally is not allergic in origin. The association between this rash and a new food could be that the byproducts of the food in the stool are irritating to the anal skin. Or the consistency of the stool may have changed making it more irritating. Changing the diaper quickly after a BM and using a diaper cream such as Desitin or Balmex may help.
Sincerely,
Dr. Warren
-JR
Dear JR: Peeling skin in a localized area of the body is usually secondary to a previous or current inflamed rash. Without seeing a rash it can be difficult to offer a diagnosis. Jock itch, which is a fungus infection could certainly cause peeling. If it is causing any discomfort or itching or is getting worse, see your doctor.
Sincerely,
Dr. Warren
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