15 March 1999
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
-AH
Dear AH: Given the timing of your son's developing Trigger Thumb after the accident, it's hard to ignore the possibility that trauma played a role in its development, but since Trigger Thumb can be congenital or develop spontaneously, I'm not sure that cause and effect can be established. In stating his experience with Trigger Thumb not being trauma related, I don't think the surgeon has anything to gain or cover up. Regardless of whether or not it was trauma related, it is clear that he had Trigger Thumb when you first brought your son for medical attention. The cause is a moot point.
Sincerely,
Dr. Warren
-JTF
Dear JTF: I am not aware of any link between cheese in the diet and behavioral or attention problems. Of course, if a child has allergy to any food, or has difficulty digesting it, that may result in his not feeling well which could contribute to behavior problems. Children who have migraines may have them provoked by hard cheeses like cheddar.
Sincerely,
Dr. Warren
- (unsigned)
Dear Parent: The American Academy of Pediatrics recommends nursing or formula for the first year. After that, it is recommended that children may be switched to whole milk to provide adequate fat for nutrition and brain growth. At two years, the American Academy of Pediatrics recommends switching to skim milk.
Sincerely,
Dr. Warren
-R
Dear R: Hormonal changes can be responsible for development of breast buds which may be tender. This is true for boys as well as girls. These hormonal changes are associated with puberty. Sometimes girls do develop some breast tissue before puberty with no other pubertal changes, and this is not a cause for alarm. However, 6 years old is too young for puberty to begin, so whether or not this lump represents normal breast tissue, I would suggest you have your daughter checked by her pediatrician.
Sincerely,
Dr. Warren
Also, how do you know when to start potty training? Each time my daughter goes in her diaper, if I ask her if she went , she runs to get me a diaper. She has always done things rather quickly for her age and she understands everything we say to her. I just don't know where to start. Thank-you!
-Samantha
Dear Samantha: Since your daughter's growth has been normal all along, there is no reason to be concerned about her weight. The 10th percentile is in the normal range. If your daughter has forsaken meals and is eating snacks instead, you have to be sure that she is eating nutritious foods at snack time. If a child with a small appetite is allowed junk food instead of meals, the child will live on junk food and not be adequately nourished. Milk is good food, but sometimes decreasing the milk intake can help to increase a child's consumption of solid foods. For a more complete discussion of child nutrition read my article, Nutrition Without Tears.
While awareness and knowledge of bodily functions are essential ingredients to the completion of toilet training, a baby's being aware that he needs a diaper change does not signify that he is ready to use a potty. Sitting on a toilet or potty is the essential first step and eliminating into the bowl (intentionally or by accident) is the essential second step for toilet training. If your child shows an interest, you can make sitting on the toilet several times a day part of her routine. Eventually something will happen into the bowl and your praise of her success will lay the foundation for her to try to keep going in the bowl. Staying clean and dry is a much later accomplishment. For more information check my article, Potty Training.
Sincerely,
Dr. Warren
-(unsigned)
Dear Parent: You will need a more accurate diagnosis to find information on the web or elsewhere since it is unlikely that there is an information source dedicated to all kinds of granulomas. As you have found, the search for information leads primarily to granulomatous diseases.
The two kinds of granulomas which are likely to be found in a healthy child are umbilical granulomas and pyogenic granulomas. An umbilical granuloma is what is left behind after the umbilical cord falls off. Most shrink and get covered with skin, but some grow and ooze and need to be cauterized or removed. A pyogenic granuloma results from trauma. Normally, an injury that breaks the skin results in scar tissue forming inside the injury and on the skin in order for the wound to heal. If, for some unknown reason, the normal process of skin growth over the wound goes awry, granulation tissue from inside may grow out from the wound resulting in a pyogenic granuloma.
From the little description you gave me, it sounds like you're talking about a pyogenic granuloma. If you're concerned about anesthesia, you should ask your surgeon about the prospects of performing the surgery with a local anesthetic and sedation. Much younger children undergo much more complicated surgery when necessary, for example, open heart surgery in newborns with congenital heart defects. Your child is not to young to have necessary surgery. You should discuss the risks of not doing the surgery as well as the risks and benefits of the surgery with your doctor.
Sincerely,
Dr. Warren
It is very itchy! 'They' are red spots all over my body, some with a whitish flakey cover on them, others without. Fever comes and goes but nothing to go to hospital room over. I have had zero energy and basically just feel weak and exhausted.
I must say that I have had chicken pox before as a child and that and the fact that it is getting worse and not better (spreading more and more) leads me to wonder if this isn't something else? The doctor who diagnosed me did not see me in an examining room or even look at all of them. She came outside where I had to wait for her because of the contagous nature of chicken pox.
Is there something else this may be? And if not, when is it going to get better? When is it going to go away?? Please respond as quickly as possible. I am going CRAZY!! Thank you so much.
-JQ
Dear JQ: The average case of chicken pox does not last 10 days. That, plus the fact that you had chicken pox before (assuming that is accurate), makes the diagnosis of chicken pox questionable. If, indeed, you have chicken pox at your age, and it isn't getting better, you should be taking Zovirax, an antiviral medication. Therefore you should contact your doctor.
I won't even hazard a guess as to what your rash may be. Since pediatricians have more experience with chicken pox than most other physicians including dermatologists, you might see if you can get a friendly pediatrician to look at your rash. If it isn't chicken pox, you should see a dermatologist.
Sincerely,
Dr. Warren
Thanks,
-Worried Teenager
Dear Worried Teenager: When urine is concentrated it has a strong odor. The urine will be concentrated when you don't drink enough fluids. Certain foods will also cause a strong odor in the urine, most notably, asparagus. Therefore, a strong smell to the urine is not necessarily abnormal. You might take note of the relationship of the smell to your diet to see if any particular food is causing it. You can also try drinking more liquids to see if it helps.
If the smell you are describing is foul, you might want to have a urine culture done to be sure there isn't any infection.
I don't think you need to be alarmed about the smell of your urine, but if my suggestions don't make a difference and you are concerned, you should see a doctor. What you should be concerned about is having unprotected sex. It only takes ONE time to cause an unwanted pregnancy or get a sexually transmitted disease, including AIDS.
Sincerely,
Dr. Warren
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