17 August 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
-RVP
Dear RVP: Since babies have a higher metabolic rate than adults it is not unusual for them to sweat and become overheated if they are overdressed or held closely. Vitamins have nothing to do with it. If your baby perspires during a feeding because feeding is a major effort for her, which would be evident because she would become fatigued during the feeding and not feed well, then there could be something wrong such as heart disease. If, on the other hand, she feeds well and is vigorous during and after the feeding, and is gaining weight and growing well, the perspiration would probably not be significant.
Sincerely,
Dr. Warren
As part of his normal behavior with other kids his age, we have taught him the importance of not hitting out at other children. What we are finding now is that from time to time, he gets hit by other kids and he comes crying to us. Sometimes, even kids younger to him hit him in play and he comes to us crying.
Our concern is - did we do the right thing by not encouraging him to lash out at kids that hit him? What should we do?
Waiting for your reply
Yours faithfully
-Mr. & Mrs. K, India
Dear Mr. & Mrs. K: The most important thing any of us can do to make this world a safer world is to teach all of our children that violence is not a solution to anything. You have been absolutely right to teach your son that it is not acceptable to hit others. The next step to teaching him nonviolence is for him to learn that he is not powerless just because he doesn't use his fists. As his language skills increase he must learn to use humor and intelligence to deal with situations that may lead to violence and to help himself deal with situations in which he has been violated.
I hope that in some of the situations where others have hit him the other children were corrected by you or their parents since your son must also see that there is justice in the world and that he can turn to authority figures to protect his rights.
In the meanwhile, since you describe your son as outgoing and social, it appears that these few incidents have not had an adverse effect on him. In the end, his ability to share and get along will win him friends and allies so that he will not always be a target of bullies.
I should also point out that at 3-1/2 years old many children cry to their parents when they are hit by others. If it hurts physically or emotionally, it doesn't matter whether the source of pain is bigger or smaller than you. In fact, many of the children who hit may cry to their parents rather than fight back if hit by another.
Sincerely,
Dr. Warren
-FH
Dear FH: Tylenol, Ibuprofen, and many other drugs are metabolized in the liver. When taken chronically some people develop liver inflammation which is usually reversible on discontinuation of the medicine as long as toxic doses are not given. If you use these medications occasionally, even if some days require several doses, there is little cause for concern. But since all medications have side effects, if you find you are using medications frequently, you may need to reevaluate the need for medication, and considering the risk/benefit ration, raise the threshold for the degree of symptoms you medicate.
Sincerely,
Dr. Warren
The doctors here have been great, but still can give us no answers. I would be interested in getting something just anything to help us to understand what is in store for our little girl.
She has been tube fed up till just two months ago, and is now able to eat certain purees and liquids, but it is a struggle as she seems to have no desire for food. She is only 28 pounds and is unable to walk or talk, yet she can peddle a tricycle all over the place and bumb scoots everywhere, and can babble. She knows certain sign words and seems to understand EVERYTHING, when she wants to! Yet how come she can't speak? She is able to stand for a few seconds with help, but will she ever walk? I have so many questions, and hardly any answers....Can you help?
I look forwards to your response and thank you.
-R
Dear R: I was unable to find any information in texts or on the internet regarding Chromosome 14 Band 32 Long Arm Deletion. A Medline search produced the following abstract:
Authors:
Ortigas AP , Stein CK , Thomson LL , Hoo JJ
Department of Pediatrics, SUNY Health Science Center, Syracuse 13210, USA.
J Med Genet 1997 Jun;34(6):515-7
Abstract: A patient with a 14q32.3 terminal band deletion and cat cry is reported. Review of four other 14q32.3 deletion cases suggests the possible presence of a recognisable 14q32.3 terminal deletion syndrome, which is characterised by (1) apparently postnatal onset of small head size in comparison to body size, (2) high forehead with lateral hypertrichosis, (3) epicanthic folds, (4) broad nasal bridge, (5) high arched palate, (6) single palmar crease, and (7) mild to moderate developmental delay. Although none of the above seven features in unique to this syndrome, and indeed are quite common in other chromosomal disorders or genetic syndromes, patients with a terminal 14q32.3 deletion do show a recognisable facial gestalt. Interestingly, unlike ring chromosome 14, the 14q32.3 terminal deletion has rarely been reported, possibly because it is harder to detect, and an optimal chromosome preparation is required for its identification.While I found no Web sites that dealt specifically with the chromosomal anomaly about which you inquired, the following Web sites may be useful to you:
Sincerely,
Dr. Warren
-BH
Dear BH: The medical opinion on tibial torsion has changed over the years. Most tibias straighten out on their own. Years ago, orthopedists prescribed bars with shoes attached which the infant had to wear at all times including during sleep. The shoe position was adjusted to rotate the foot to the desired position. Some orthopedists became concerned that this may lead to future hip problems.
By three years of age, any attempt at correction would be difficult. The only nonsurgical approach I know would be to use braces with twister cables. Orthopedists also use wedges and pads in the shoes to adjust the position of the feet, but while this may improve the gait, it does not change the structure of the leg. Often the concern is largely cosmetic. Parents are concerned about the appearance of the legs but the child has no difficulty walking and running.
The most useful thing you can do, besides getting another opinion (which you should definitely do if you have any concerns you feel haven't been answered by the first opinion) is to make sure your daughter does not sit on the floor with her legs under her in such a way as to keep the inturned leg turned in and the outturned one turned out.
Sincerely,
Dr. Warren
-Tim
Dear Tim: There is no medical condition I know of called "Water Head Baby." My guess is that the child has hydrocephalus, which is a collection of fluid in the brain. This results when the flow of cerebrospinal fluid is obstructed or rarely from overproduction of cerebrospinal fluid. The increased fluid in the head causes the head to enlarge rapidly and causes pressure on the brain. It must be treated by surgically placing a shunt to remove fluid from the brain. Untreated hydrocephalus causes severe brain damage. When it is treated early, patients who have hydrocephalus do well.
Sincerely,
Dr. Warren
-CG
Dear CG: Infants may develop enlargement of their breasts from exposure to their mothers hormones in the uterus. A small number of these infants have persistent enlargement of their breasts. Yet others may develop some enlargement of the breasts later on. If the enlargement does not continue to grow and there is no pubic hair or acceleration of growth as seen in puberty, this is not a cause for concern. If there should be any additional signs of pubertal development, she should be evaluated by an endocrinologist.
Sincerely,
Dr. Warren
-C
Dear C: Stridor is a noise that results from breathing through a narrowed or obstructed upper airway. In the extreme, stridor is associated with difficulty breathing. It is most commonly seen as part of croup. It is not commonly associated with cerebral palsy. If the neurological condition of a child with cerebral palsy results in vocal cord dysfunction, the child may have stridor.
Sincerely,
Dr. Warren
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