9 November 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
Thank you very much.
-Mrs. D
Dear Mrs. D: Nightmares may sometimes be the result of stress, but they have no long-term ill effects. Night terrors differ from nightmares. During a night terror the child is not actually awaken and doesn't calm in response to his parents comforting him because he does not recognize them in his sleep. Most children who awaken from night terrors may feel ill at ease but have no recollection of what happened. Night terrors may also be brought on by stress. They are considered a form of sleep disturbance. They generally occur the same time each night and may sometimes be prevented by waking the child before his usual night terror "appointment" and then getting him back to sleep. There is no need to see a doctor about nightmares or night terrors unless you believe your child's sleep is disturbed because he is not well or there is some indication of a problem during the day.
Sincerely,
Dr. Warren
I have a daughter who is almost 10 mths old, was 3 wks early when she was born, diagnosed with reflux at 3 mths and is still on Propulsid and Zantac for it.
She will drink juice and water from a cup with no problem, but will not take milk or formula. She will drink an ounce or so and then wants no part of it. She won't take anymore until I give her a bottle. Our ped said that I should hold the bottle for her so that she doesn't get attached to it. I do that most of the time, there are times when she helps me.
I don't know what to do really. We've tried 5 different cups with the same results.
Thank you for your response in advance.
-Nancy
Dear Nancy: I don't see what the rush is to get a 10 month old off the bottle. Holding the bottle for her may create a nice bonding experience for the two of you, so I have nothing against that, but a 10 month old should be able to use a bottle independently. I can't see any reason why her emotional attachment to the bottle would be decreased by not letting her hold it. If you want to avoid attachment to the bottle as well as do her teeth a favor, make sure you give it to her only to drink her milk and don't let her walk around with it or give it to her to comfort her.
Encourage your daughter to become proficient at using the cup and don't pressure her to drink milk from it. Continue to offer her the ounce of milk that she's willing to drink from the cup and give her her bottle as well. When you feel your daughter is ready to eliminate the bottle, then you can just eliminate it. Some children stop drinking milk for a while after their bottles are discontinued. By two years of age most babies are getting the bulk of their nutrients from solids and can substitute yogurt for milk so it's not a problem if they give up milk temporarily. Once they get used to the idea that they won't be getting bottles, most babies will drink their milk from a cup.
Sincerely,
Dr. Warren
Background:
My daughter experienced serious invasive Haemophilus influenza type b infection (manifested as serious meningitis accompanied by septicemia) when she was 14 months old. Disease was successfully treated in a specialised hospital (10 days of intensive care, all together 6 weeks) with a result -> fully recovered without evidence of neurologic sequelae (blood tests - normal, EEG - normal, CT normal ... )!
Immunisation against Hib is NOT a routine one in Croatia (Europe) where we live! My daughter received a first dose of Act-HIB vaccine (produced/distributed by Institut Merieux GmbH, 69181 Leimen) after she recovered from disease, when she was 15 months old! One month after immunisation, blood test was performed with result: 'Antibody to the Hib - IgG negative'!
Second immunisation with same vaccine type (Act-HIB) was performed two months after first one (when she was 17 months old)! Blood test results, one and two months after second dose, were the same again ('antibody to the Hib - IgG negative').
Third dose of the same vaccine (Act-HIB) was administered 3 months after second one (when she was 20 months old). Blood test result, two month after third dose, was again the same ('antibody to the Hib - IgG negative')!
Before and after a mentioned Hib disease my daughter has not had any other serious disease (few times she got cold only)! She is a normal, healthy two years old child now (94 cm, 16 kg, she already talks a lot ...)!
Questions:
-NG
Dear NG:
Sincerely,
Dr. Warren
-MR
Dear MR: Making diagnoses involving rashes without actually seeing the rash is extremely difficult. Even with your excellent description I might have a completely different impression if I saw it in real life. Since your daughter's illness began with a sore throat, the first thing that comes to mind is scarlet fever. Scarlet fever is caused by Strep, which would mean that her throat culture should be positive if it is scarlet fever. Scarlet fever would respond well to treatment with antibiotics although the effects of the erythrogenic toxin which produces the rash may not resolve immediately.
Swollen glands in the neck are common with Strep throat, but it would be unusual to have tender swollen glands in the groin. Since your daughter had a sore throat two weeks ago, if that was also Strep, one has to think of rheumatic fever as a cause of severely tender, swollen joints; however, the red palms would not be seen as part of rheumatic fever and the joints involved are generally large joints.
Kawasaki Syndrome is a rare disease characterized by high fever for a minimum of 5 days, a red rash similar to the rash of scarlet fever, conjunctivitis, swollen lymph nodes (glands), inflammation of the mouth and tongue, swelling and redness of the palms and soles, fatigue, and irritability. The diagnosis is made on the basis of the symptoms, which may not all be present. There is no lab test to make the diagnosis although an elevated platelet count is a common characteristic. The cause of Kawasaki Syndrome is unknown. Kawasaki Syndrome causes inflammation of blood vessels. This can result in complications involving multiple organs, especially the heart. Kawaski Syndrome is the main cause of acquired heart disease in children. One of the heart problems caused by Kawasaki Syndrome is coronary artery aneurysms (small balloon like swellings of the wall of the artery). The coronary arteries supply blood to the heart muscle. Blockage of these arteries by atherosclerosis causes heart attacks in adults. The risk associated with the coronary artery aneurysms of Kawasaki Syndrome is that clots may develop in the aneurysms blocking blood flow to the heart. When the diagnosis is made early, high doses of intravenous gamma globulin can often prevent or minimize aneurysm formation. When aneurysms do occur, medications like aspirin and persantine are used to help prevent clotting. Early diagnosis is the key, but the diagnosis can't be made before 5 days of fever. To the best of my knowledge joint symptoms have not been described as part of Kawasaki Syndrome.
Sincerely,
Dr. Warren
-Sharon
Dear Sharon: The disorder you are asking about is Cushing Syndrome which is a result of excess hydrocortisone production by the adrenal gland. Stretch marks (striae) are a minor characteristic of Cushing Syndrome. These patients have high blood pressure and a characteristic obesity with a round face and a hump on the back. They also usually have acne and virilization (characteristics caused by male hormones) which in girls means deepening of the voice, increased facial hair, and enlargement of the clitoris.
Striae also occur in healthy people. Increased growth of muscle or fat can stretch the skin. Rapid weight gain can cause stretch marks. Sometimes stretch marks develop during the adolescent growth spurt. Some body builders develop striae in areas where they have large muscle growth.
Stretch marks alone, in the absence of other findings, do not indicate any disease or disorder.
Sincerely,
Dr. Warren
-D
Dear D: The Amican Academy of Pediatrics recommends introducing soilid feedings like cereal and jarred purées when an infant has good enough head control and swallowing control to fed by spoon. This is generally not before 4 months. If a baby is doing well on nursing or formula alone there is no rush to introduce solid feeding before 6 months. If your baby holds his head up well and is eating well off a spoon, at 4 months he is not too young for spoon feeding.
For more information read my article, Feeding Your Infant.
Sincerely,
Dr. Warren
Thank you for your time.
-Lana
Dear Lana: Congratulations on your upcoming delivery!
Most newborns eat approximately every 2-1/2 to 3 hours. This interval will gradually stretch out to 4 hours with some periods of longer sleep. The average newborn consumes between 2 and 4 ounces at a feeding. As a general rule the baby will let you know exactly what she needs. When she is full she'll stop eating. If she's hungry, she'll wake up to eat. I recommend feeding on demand, but try to avoid feeding a few sips, having the baby go to sleep, and then waking every half hour for a few more sips.
Formula is a complete and nutritious food. There is no need to add cereal and no nutritional benefit. Cereal should be introduced on a spoon when the baby is old enough for spoon feeding, generally not before 4 months. If the baby is doing well on formula alone there is no rush to introduce cereal or other solids before 6 months.
Human milk is also a complete food and has some additional health benefits as well. If you haven't considered nursing your baby, you should think about it. Many mothers-to-be don't consider nursing because they are worried about their ability to produce milk, but I would assure you that if nursing didn't work no humans would have been around to invent bottles and formula. Some mothers-to-be worry that they won't like nursing. To them I say that they should try it and see. You can always decide to offer formula if you're not having a good experience with nursing, but your chances of success aren't very good if you feed the baby formula for a while and after that decide you'd like to try nursing.
For more information read my article, Feeding Your Infant.
Sincerely,
Dr. Warren
-MSM
Dear MSM: Most boys stop growing between 18 and 21 years of age. Growth ceases when the growth plates of the bones fuse after the body has fully matured sexually. If, as is most likely at 24 years of age, you have already gone through puberty and stopped growing there is nothing that can be done to make you grow again.
Sincerely,
Dr. Warren
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