12 October 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
My 8 year old daughter has a high pitch, screechy voice, soft in sound, sometimes cracks at the end of a sentence. Actually she likes her voice as does everyone else in the family!!!!
The speech teacher at her school suggests having an ENT man check out her vocal chords...this means sticking a tube down her throat. (I doubt if she could get through this kind of checkup!).
My pediatrician thinks this is RIDICULOUS inasmuch as she has always had a high pitched screechy voice all her life. (my husband has a high pitched voice too).
Do you think I should have an ENT man check this out????- AM i endangering her by leaving her alone and not following up on the checkup???? What would an ENT man do if they found polyps or something on her vocal chords.....????? What is your opinion????? - I want to be sure I am doing the right thing for her!
Thanks again.
-Carrie
Dear Carrie: Thanks for the Kudos.
Most vocal chord nodules result from overuse of the voice. They cause the voice to be hoarse, which is often low pitched rather than screechy as you describe. If your daughter's voice has always sounded like it does and you haven't noticed a change, it is likely that there isn't anything to be concerned about. This opinion appears to be confirmed by your pediatrician who doesn't feel anything is wrong.
Just to play devil's advocate, let's assume that your daughter's voice has changed slowly over a period of time so that neither you nor her pediatrician have noticed it. If you'd like an independent opinion that doesn't involve shoving anything down your daughter's throat, have her evaluated by another speech pathologist. If the second speech pathologist is convinced there is a problem, consider seeing an ENT.
The ENT may be able to do an initial evaluation with mirrors, but if he does have to look at your daughter's vocal chords with a scope, he will use a spray to anesthetize your daughter's throat rather than torture her. If you must go for the procedure, be sure to talk to the doctor about it first so that you won't take your daughter there and project your anxiety to her. Have him explain the risks and benefits of the procedure along with the potential risks of not doing anything so that you can make an informed decision.
If your daughter has vocal nodules, the treatment is speech therapy. Therefore, if the speech pathologist is convinced that your daughter is using her voice incorrectly, you might even go for a course of speech therapy before committing to a look. And let me assure you that your daughter won't lose her unique voice by using it correctly.
Sincerely,
Dr. Warren
-EM
Dear EM: Often the distinction between normal and abnormal behavior in adolescence is a matter of degree. It is certainly normal for teens to be rebellious and to try to set new boundaries by testing and stretching limits, but it sounds to me like there is a significant problem if your son is always angry. The anger which is directed at you (his parents) may stem from other aspects of his life that really have nothing to do with you. It sounds like your son really needs to talk to someone. The problem is, that someone may not be you.
In order to listen to what's on a teen's mind parents have to be willing to listen to some pretty awful stuff without being judgmental, correcting their child, or arguing with him. If you become defensive, you won't get to the feelings or their cause. What a counselor knows is that all feelings are legitimate and have to be dealt with regardless of whether the reasons presented for the feelings appear to be based in fact. The counselor's lack of emotional involvement in the issues being discussed make it possible for him to deal with them in a nonjudgmental way, initially dealing with what is said at face value and eventually delving deeper into the factors underlying the problems.
Your son may have said he doesn't respect you out of anger, but if he really feels that way and this is a major issue for you, professional counseling is in order. In any event, physically forcing a 13 year old to comply with his parents wishes is not the way to go. If he hasn't learned to respect your wishes and follow your rules by 13, and to discuss the things he wants to be changed in a civilized manner, it won't be any better when he's 16 and probably too big to force. It sounds to me like you would all benefit from counseling. For some additional advice you should read two of my articles regarding child behavior: Managing the Difficult Child: The Child Who Refuses to Cooperate and Surviving Your Child's Adolescence.
Sincerely,
Dr. Warren
-KI
Dear KI: The two main types of holes in the heart are VSD (ventriculoseptal defect) and ASD (atrial septal defect). The ventricles are the two main pumping chambers of the heart. A child who has a VSD has a hole in the wall that divides the two main pumping chambers. The atria are the two smaller pumping chambers. Blood which is returned to the heart is collected in the atria and then pumped into the ventricles. A child with an ASD has a hole in the wall that divides the two atria.
The left atrium collects oxygenated blood from the lungs and sends it to the left ventricle for delivery to the body. The right atrium collects blood returning from the body and delivers it to the right ventricle to be pumped into the lungs where it picks up oxygen. The left side of the heart is a high pressure circuit because it must deliver blood to the whole body. The right side is a lower pressure circuit since it delivers blood into the low pressure blood vessels of the spongy lung tissue. As a result, holes in the heart usually result in blood flowing through the hole from the left side of the heart into the right side of the heart. This results in fluid overload into the lungs and it makes the heart work harder to deliver the blood needed to the body. The fluid overload to the lungs can ultimately result in an increase in resistance in the lung blood vessels (pulmonary hypertension) and eventually cause the blood flow to reverse across the hole from right to left, decreasing blood flow to the lungs and causing difficulty getting oxygen into the blood.
Large holes in either chamber must be repaired. Small holes may be insignificant and may even close. A small hole may cause a loud murmur. If there is any hole at all, the patient must have antibiotics before dental work.
Sincerely,
Dr. Warren
Sincerely,
-Mr. & Mrs. R
Dear Mr. & Mrs. R: If the Pediazole is responsible for your son's bleeding gums the possibilities are that your son has stomatitis (an inflammation of the mouth and gums) caused by the sulfonamide in the Pediazole. Another, even more serious possibility is that the sulfonamide has affected your son's bone marrow and his platelet count. Platelets are essential for proper blood clotting.
The local care that the pediatric dentist is having you apply to your son's gums may sound strange, but it is appropriate; however, it is just local care for the gums. Your son needs a thorough medical evaluation to determine if he needs medical care for an adverse reaction to medication. In addition, your son needs reevaluation of his pneumonia to determine if additional antibiotics are needed since the Pediazole was discontinued.
Sincerely,
Dr. Warren
I think it is wonderful you are helping people! Thanks so much.
-D
Dear D: Two weeks is a long course for diarrhea due to any cause. Most virus infections should have fully resolved in that length of time. If your daughter's bowel movements are not large or frequent, they will not cause significant water loss, and if her fluid intake is good, there should be no risk of dehydration. As long as there is no risk of dehydration and your daughter is receiving adequate nutrients in her diet, the diarrhea can take however long it takes to clear up without being a danger to your child.
The BRAT diet is somewhat useful because it won't aggravate diarrhea. Kaopectate can firm up the stool somewhat. But neither Kaopectate nor the BRAT diet do anything to cure diarrhea. After two weeks it might be a good idea to send a stool culture and a stool for ova and parasites to look for a cause for the diarrhea. By reviewing the pattern of your daughter's diarrhea and her dietary history, your doctor can try to determine if she simply has an irritable colon rather than real diarrhea, or if she is lactose intolerant. If the diarrhea continues, a consultation with a pediatric gastroenterologist may be in order.
Sincerely,
Dr. Warren
Thank you
-LA
Dear LA: After 4 days on antibiotics I would be concerned about a patient with an infection that was still swollen, tender, and causing fever. It may indicate a need for a different antibiotic or hospitalization for intravenous antibiotics. A complete blood count may help your doctor decide as will his examination of the infected lymph node. If the area has abscessed, it may require drainage by a surgeon before it will clear up.
Sincerely,
Dr. Warren
-M
Dear M: There is no physical danger associated with your behavior unless the diapers you use have any toxic materials in them. Since the manufacturer would not expect anyone to suck on the diapers, that information may be difficult to obtain, so I would have to suggest some caution. I think you knew before you even asked that your behavior is somewhat strange. If you wet yourself in public there is the risk of leakage and the possibility of being found out because of the smell. You have kept this behavior a secret from your parents because you know it won't be acceptable, and yet, your mother must wonder why there are smelly wet panties and bed linens in the wash. I suspect that part of you must enjoy the risk of being caught. Another part of you must realize that this is socially unacceptable behavior which you will have to give up sometime. If you are found out, you will be ostracized by your peers.
I would have to guess that you find a certain security in regressing to an infantile behavior and are in some way not at all ready to deal with the social demands of being an adolescent. Some people find sexual pleasure in regressing to infantile behaviors such as wearing diapers or wetting themselves. This is known as infantilism. If you were an adult who chose these kinds of behaviors, I'd have to say it's your choice, and as long as you don't involve anyone else against their will, it's nobody else's business. However, since you are just on the threshold of developing sexuality and adolescent social relationships, I would have to recommend that you explore your feelings and behaviors with a professional counselor so that you don't make mistakes you later regret or find yourself in a situation you can't handle.
Sincerely,
Dr. Warren
Here is my question. My one year old and five year old have the chicken pox. My one year old has a lymph node that our doctor has told us to monitor. It is normally small and moveable, but enlarges with illness. I am aware that this is normal. My doctor said only to worry if it continues to enlarge and becomes unmovable.
As I read about chicken pox I found a reference that said swollen glands of the neck are not a part of the symptoms. However, now that my one year olds pox are in full gear she has three swollen lymph nodes in her neck. My Mother's wit says chicken pox is a virus and viruses cause nodes to swell, especially in a younger child with a less mature immune system. Then there is my fear of the worst that says it could be something awful.
So can chicken pox cause nodes to swell?
Thanks,
-G
Dear G: Chicken pox may cause swollen glands all over the body, not only because it is a virus which tends to cause swollen glands, but also, because some glands may swell in response to local inflammation in the skin from the pox. The finding of swollen glands with chicken pox is not at all worrisome.
Sincerely,
Dr. Warren
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