26 October 1998

1. Antibiotics Can Decrease Appetite
2. Breast Reduction Surgery for Boys
3. Worries About Growth
4. Breast Development
5. Bottle Rot
6. Normal Weight Gain in Japan
7. Wry Neck
8. Gas Pains From Solids?
9. Disclaimer

• Read Questions & Answers in Another Column

Antibiotics Can Decrease Appetite

Two weeks ago our son had a voracious appetite, knocking out a 4 oz. bottle every 2-3 hours. Now we're lucky (and excited) if he takes 3 oz. every 3-4 hours. Are the antibiotics the problem. We also switched formulas about two weeks ago but until he started taking the medications our son seemed to be doing fine with the change.

We're getting increasingly frustrated and are concerned about his day care and whether they will be able to keep him satisfied and hydrated.

-Mr. & Mrs. Q

Dear Mr. & Mrs. Q: It is possible that antibiotics are upsetting your baby's stomach and decreasing his appetite. It is also possible that his appetite is decreased by the ear infection or the cold that often accompanies ear infections. The caloric loss associated with decreased appetite during illness is rarely a problem when the duration of the illness or antibiotic treatment is limited such as for treating an ear infection. If the baby doesn't want to eat, be sure to offer Pedialyte as a source of fluids. If the baby's intake of fluids is poor and he isn't wetting adequate diapers to tell you he is well hydrated, have him checked by his pediatrician.

Sincerely,
Dr. Warren

-TM

Dear TM: If your son is suffering significant emotional distress to the degree that he is losing weight and avoiding swimming and gym because of enlarged breasts, you should certainly consult a plastic surgeon about breast reduction surgery. It is true that male adolescent gynecomastia often resolves, and if a boy is dealing well with the problem, surgery should be avoided, but two years of distress is more than enough to warrant surgery.

Sincerely,
Dr. Warren

She was born at 6 # 4 oz. and has never had a big appetite. However, growth was steady and satisfactory until she had a bout with reflux, stomach virus (3 days) and ear infection within the same 4 month period (5 to 9 months old).

It's taken some time but with the addition of six teeth and a little creativity, she now eats quite well (mostly table food with the exception of fruit which she still eats mostly from the jar). A typical day's eating for her is:

4 - 8 oz. of formula with a jar of baby food mixed in, 1 beef link sausage (or scrambled egg with cheese), 1 bagel with cream cheese and/or jelly (breakfast)
vanilla wafers and 4 oz. of Tang (snack)
chicken fingers, cucumber slices, fruit salad and 4 oz. whole milk (lunch)
graham crackers, cheese cubes, carrot sticks (snack)
Beef and pasta, assorted vegetable cubes, 4 - 8 oz. juice (dinner)
8 - 10 oz. formula with fruit mixed in (evening snack)

Should I be concerned about AIDS, Cancer, TB, etc? These awful things keep popping into my mind as I can't think of any other reason while a baby initially won't eat, then starts eating but can't gain weight. For the past 2 month her temp. has been 99.7 3-4 times a week. She seems to sleep more (she never used to take naps). She began being introduced to the "1 year-old room" at 10 months because she was already walking and self-feeding and can say a few words. She is quite active in her new environment. Could this explain her new sleeping habits? What about her new suseptibility to colds ( she's had 3 in two months)? Please help!!

-Worried Parents

Dear Worried Parents: Your daughter's current height is in the 25th to 50th percentile for her age while her weight is in the 5th percentile. She is slim, but her measurements are well within the normal range. If her previous height was 31-3/4 inches and now she is 29 inches, obviously there was an error in measurement, therefore you can't conclude from those measurements that she hasn't grown. With her height in the 25th to 50th percentile it is certainly reasonable to wait and see what her growth does. Since you didn't mention her prior weight I don't have a sense as to whether her weight gain was inadequate or if she was always slim, but her diet sounds reasonable, so on that basis I would also say wait and see what happens unless your pediatrician feels that her weight gain has been unsatisfactory.

Temperatures of 99.7 are normal. They do not represent fever or illness. There is no reason to consider AIDS, cancer, or TB from the information you gave me. Increased activity level could certainly cause you child to need more naps. I'm not familiar with the "1 year old room" but if it is a setting with other children who are mobile and sharing toys, remember that they are also sharing germs and therefore more likely to get more colds.

Rather than looking at numbers like height and weight, have your pediatrician review your child's growth chart with you so that you can see if she is maintaining a normal growth rate for her body size. Remember to ignore the erroneous height measurement. If the review of the growth chart shows any evidence of a problem you might then review your daughter's diet with a nutritionist to be sure that it is adequate and discuss with your pediatrician the possibilities for evaluation of slow growth.

Sincerely,
Dr. Warren

Thanks for taking the time to answer questions, we appreciate it!

-Nancy

Dear Nancy: Young girls may start puberty as early as eight years old. The first sign of puberty is breast development. The breast bud feels like a swelling under the breast and may be heard. It may also be slightly tender. As the breast bud grows it becomes obvious that it is breast tissue rather than something under the breast. The first breast bud may appear on only one side. The other side will follow quickly. You are most likely describing a breast bud in your daughter, but if you cannot be sure that this is correct, you should have her checked by her doctor.

Sincerely,
Dr. Warren

Thanks,
-LC

Dear LC: If babies go to sleep with milk or juice in their mouths, the teeth are bathed in sugar which promotes decay of the teeth (cavities). A baby should never fall asleep with a bottle in his mouth. If he takes a bottle right before bed it is best if the last few sips are plain water so that the sugar is rinsed off the teeth and doesn't remain in the mouth.

Sincerely,
Dr. Warren

Here I am told that the baby should double their weight after 3 months. Isn't that a lot? My daughter isn't thin and still has sumo wrestler looking legs. I am breast feeding, but with the aid of a weight scale we've determined that she takes in between 750 - 800 ml. per day. My pediatrician says a litre a day is normal.

This is really stressing me out and causing a lot of stress between my husband and myself as he is insisting on supplementing the baby with formula. She almost always refuses though. Please send me some advice.

Sincerely,
-SS

Dear SS: Your infant's weight, which was slightly below the 50th percentile at birth, is now at the 50th percentile. That means your baby is an average weight for an 8 week old and has gained weight well. It is generally accepted that a baby should double his birth weight by 6 months and triple it by 1 year. If your baby is satisfied with her feedings and is wetting plenty of diapers, since her weight gain is good, it is reasonable to conclude she is getting enough fluids and nutrients from nursing. The fact that she refuses the formula should also tell you that she is satisfied with nursing.

It may be, that in Japan they believe that little babies should be heavier to be healthy. I don't know. That would be a cultural difference. Since the Japanese are not generally larger than people in the United States, there is no reason for me to think that the growth standards for Japanese people require the infants to be heavier to be normal.

Sincerely,
Dr. Warren

She isn't as bad this time but it has made her just want to sit around and not want to do much of anything. I talked to the doctor and they just said to watch her and give her tylenol...if any other syptoms appear call back. What is the possible cause? Could something be out of line? What can be done?

-CC

Dear CC: The medical term for the condition you are describing is Torticollis. It is a spasm of one of the muscles in the neck, usually one that runs from behind the ear down to the breast bone. The head is a very heavy object sitting on top of a narrow, flexible neck. In order for the head and neck to have the range of mobility they have, the head requires strong muscles to maintain it's position. When one of these muscles goes into spasm it can cause severe pain.

A torticollis can result from sleep position, a sudden move of the head resulting in a muscle strain, an inflamed lymph node in the neck (not a common cause), or a malalignment of the spine. If your daughter is prone to this try to avoid her sleeping with her neck in an unusual position as may happen if she sleeps right up to the head board or on a high pile of pillows.

Mild pain will benefit from Tylenol, heat, and massage. Moderate pain may be more responsive to ibuprofen (Advil, Motrin). Severe pain with restriction of head movement requires a muscle relaxant such as Valium,

If the problem is recurrent she may benefit from orthopedic evaluation, physical therapy to strengthen her neck muscles, or chiropractic adjustment for any malalignment of the spine.

Sincerely,
Dr. Warren

-Julie

Dear Julie: It really makes no sense for your baby to have difficulty with all foods except applesauce. Certainly infants can be sensitive to some foods, but sensitivity to a bunch of different, unrelated foods would be highly unusual. Since you didn't tell me what foods you tried, I can't be sure if there is a pattern. In addition, you must consider what happens to the baby's bowel movements. If the baby becomes constipated from a food, it may cause gas pains, but it doesn't mean the baby is sensitive to the food. Babies sometimes need to adjust to new foods. You should try a new food for 3 days before trying another. If the baby becomes gassy after introducing a new food give the baby some time eating it before you decide that it must be discontinued unless the baby is quite distressed.

If you are unable to make any progress with solids, you might need to consult an allergist or a gastroenterologist.

Sincerely,
Dr. Warren

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