29 September 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
-WH
Dear WH: If the lump in your daughter's breast feels like breast tissue then it could be the first sign of puberty. Breast development at 8 years of age is the earliest that it would be considered normal. It may start in just one breast. This may very well be why your pediatrician was not concerned, but since he examined your daughter, you must ask him if he thinks the lump is breast tissue. If he does not think it is breast tissue, he must tell you what he thinks it is and explain why he feels waiting is the appropriate thing to do.
Sincerely,
Dr. Warren
I was told that this is usual on anyone who has just gotten out of a very high fever and had not had a bath for a few days.
I have ruled out measles because this happened when his fever disappeared and only came out after we bathed him. I also asked someone who is familiar with measles and have ruled it out herself.
Please let me know your thoughts on this matter. I will be grateful forever.
Sincerely,
-BB
Dear BB: I respect your beliefs and would not ask you to bathe your child if he has a fever, but I would also like to reassure you that it is medically safe to bathe a child with a fever. In fact, if the fever is high, we recommend bathing to help bring the fever down.
Since I haven't seen the rash, I can't be sure what it is. Roseola causes high fever for 3 to 5 days, but children who have Roseola are not very sick. When the fever breaks, the children develop a rash. Until the rash comes out there is no way to know it is Roseola. Roseola is a possibility based on your description. A reaction to the antibiotic may also cause a rash. If the rash persists, your pediatrician should look at it to tell you what it is.
Sincerely,
Dr. Warren
Sincerely,
-A concerned Aunt in Wisconsin
Dear Concerned Aunt: It is true that your nephew's colon has to shrink back to normal size, but unless he has some other medical problem causing his colon to be abnormal, it got stretched because he was a stool withholder, i.e., he refused to have bowel movements. Unless he cooperates with a program aimed at changing his bowel habits medication alone will not help. Your nephew needs the active involvement of a gastroenterologist or child psychologist who has experience dealing with this problem. He will need close follow up for adjustment of his mineral oil and laxatives and to supervise the retraining of his bowels.
Please read my article Fecal Soiling for more information.
Sincerely,
Dr. Warren
Thanks
-HS
Dear HS: Follow your instinct as a mother and get your son the most thorough eye evaluation you can get as soon as possible. Unless you have reason to believe that your son is a hypochondriac or tends to blow things out of proportion, his symptoms simply can't be ignored.
Sincerely,
Dr. Warren
Dear Dr. Warren: Thanks for answering my query. It is weird, but when I had a sick guinea pig over Labor Day when the vet was closed, I got about 20 replies to my questions about care, antibiotics, etc. Now that it's a child, you're one of 2 that have answered at all! I took him to another city 110 miles away yesterday to see the only pediatric ophthalmologist in northern New Mexico, but even though he examined him quite thoroughly (as far as I can tell), he could find no explanation for the double-vision effect or the loss of ability to read the line on the eye chart that he had been able to read for 2 days after the first accident. He, like the 2 other ophthalmologists, the 3 pediatricians, and the neuro-ophthalmologist friend of mine in Kansas who talked to me on the phone but didn't see William, is reduced to saying, "Wait and see if it clears up in a month or two." Since he vomits every time he tries to read for more than a minute or two, and got nauseous even trying to tell me what 2-inch-high letters in thick magic marker lines on an index card were, when he has always had 20/20 vision before (even right after the accident), this seems kind of pitiful advice, but I guess there's nothing more to be done. I tried to contact my Kansas friend's old major professor, Neil Miller at the Wilmer Clinic at Johns Hopkins, but so far he hasn't gotten back to me. Even if he did, I don't know what more I can ask them to do. My friend says fluorescein angiography wouldn't be useful for this kind of thing since it sounds more neurological than retinal and there's no sign of retinal damage. They do have ophthalmologic ultrasound at Hopkins, but again, unless there is real muscle damage (and there's no external sign of strabismus, weird nystagmus, etc.) it might not be very useful. MRI of the eye isn't usually very good resolution, as far as I'm told, and not too many people can interpret it. Any ideas of what to try next? My poor kid is already referring to it as "the dead eye" and has been making like Cyclops drawings, and pirates with eye patches on his magnetic iron-filings board (although he claims it has nothing to do with how he feels about his eye). I keep telling him how lucky it was that the stick didn't poke his eye out and that the floater has gone away, but I'm not sure he's buying it.
Thanks again for caring.
-HS
Dear HS: Since your son has had a thorough ophthalmologic evaluation by several ophthalmologists and has significant remaining symptoms, I'd have to suggest possibly a neurological exam.Your son's reaction with calling his eye dead and drawing Cyclops sounds a bit extreme and may imply a significant psychological overlay to whatever real symptoms he still has. Therefore, you might also want to consider exploring the psychological aspects of his problem. If he played any active role in the cause of either accident, guilt and a conversion reaction could play a significant role in his symptomatology.
Sincerely,
Dr. Warren
How can we get our son out of the habit of crying at night (2-4 times) just to sleep in our bed. I know we created this problem, but we don't know how to fix it.
Please email any advice
-BZ
Dear BZ: Babies can learn a new, undesirable habit overnight. Three months ago when you took your son into your bed, whatever else may have been going on that contributed to his waking, he was at the peak of separation anxiety. One of the things he wanted was to not be alone. That 's a legitimate need, but learning to go to sleep alone, is also a legitimate goal. If you want him to stop crying out to be brought into your bed, you have to stop taking him into your bed. That doesn't mean just leave him in his crib screaming, but if you don't take him into your bed, you're going to have to spend a good part of several nights comforting him until he begins to get comfortable with the idea of staying in his bed. I can see how it might be easier to take him into your bed, but if you're going to stop, it has to be all the way. Please read my article Helping Your Child to Sleep Through the Night.
Sincerely,
Dr. Warren
Can you offer your advice and comments?
-TE
Dear : If I had to pick an age by which to eliminate the bottle, I'd say by two, but some children at two aren't ready. The trick at this age is to offer your baby a pleasant experience with the cup and not make it either cup or bottle so that she doesn't associate the cup with loss of the bottle. You don't want to miss the signs that your baby is ready to give up the bottle and end up keeping it too long because it's more convenient, but at one year, if she isn't ready, let her enjoy her bottles.
Sincerely,
Dr. Warren
-A Concerned Mom
Dear Concerned Mom: Rashes are one of the most difficult things to diagnose and talk about intelligently without seeing them. Itchy bumps and patches could be hives, which is an allergic reaction. Hives may occur in response to infectious illnesses. An antihistamine such as the one found in Dimetapp, can help to control the allergic reaction.
If the rash is fine, red bumps giving a sandpapery feel to the skin, since your daughter had a sore throat, you could be describing Scarlet Fever,. Scarlet Fever can be seen with some forms of Strep Throat and requires antibiotic treatment.
Many virus infections cause rashes, and so the rash may simply be part of the illness if she had a virus infection.
Sincerely,
Dr. Warren
-MD
Dear MD: It is certainly possible for a 5 month old to be overweight. At 26 inches long your son's height is in the 50th percentile whereas his weight of 20 pounds is at the 95th percentile. This differential between weight and height percentile suggest he may be overweight, but a lot depends on his body build. What is more important is whether his weight has been steadily increasing along the 95th percentile for a while or whether it has been crossing percentile curves going from the 50th percentile to the 95th percentile. You should review your child's growth curve with his pediatrician and if it shows that he has been continually gaining weight faster than height, there is a cause for concern. If his weight gain is steadily at the 95th percentile, then just accept that as his current body build.
Sincerely,
Dr. Warren
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