29 March 1999

1. The Doctor Says It's "Weak Lungs"
2. Urine Infection in Boys
3. Umbilical Hernia
4. Managing Timeouts
5. Tonsillar Crypts, Tonsillar Follicles
6. Sleep Habits of Adolescents
7. Shingles or Some Other Rash
8. Skim Milk for Kids
9. Disclaimer

• Read Questions & Answers in Another Column

The Doctor Says It's "Weak Lungs"

I'd appreciate you answering these questions. Thank you for your time.

-GL

Dear GL: Unfortunately, sometimes when physicians give patients explanations they use words that are not medically accurate. Some children may be prone to develop bronchitis or pneumonia, or have asthma resulting in frequent lower respiratory problems. Cystic fibrosis can result in chronic obstructive lung disease and recurrent pneumonia. But there is no medical condition known as "weak lungs." Since I don't know what the child's actual medical problem is, I cannot comment or advise on it.

Large tonsils are a problem if they are chronically infected or cause upper airway obstruction with loud snoring and sleep apnea (brief pauses in breathing). If neither of these problems are occurring, the tonsils should be left alone.

Sincerely,
Dr. Warren

My son is 13 years old and a very healthy, happy, and active kid... He has already achieved a 'youth' black belt in Karate - they are not very aggressive in sparring and wear protective equipment...

A few weeks ago Gerry developed a mild fever, chills & sweats, had painful urination and some blood in his urine. The next day he was seen, a culture was taken - bacteria discovered, meds prescribed, and within 48 hours, fully recovered. Two days prior to the incident he drank a half gallon of raw (unpasteurized) apple cider with a label cautioning against bacteria. He naturally had the runs. He also often makes a concoction of soap bubbles for his bath...

We've been told ' boys are not allowed to have bladder infections and have been asked to have a procedure done that involves catheterization, filling the bladder with a dye, and x-raying to see if any urine is backing into the kidneys. How do you know the difference between a bladder or urinary track infection? Can raw cider or bath soap cause this?

Given all this - and on the first incident of an infection, is this the accepted procedure and why?

Thank you for your comments.

-HK

Dear HK: The bladder is part of the urinary tract. A urine infection in a 13 year old boy with no urinary tract abnormalities is unusual, therefore your son should have a complete evaluation of his urinary tract. The bacteria from the cider would not have direct access to your son's urinary tract, so the cider is not likely to be related to the infection. Bubble baths can predispose to urinary tract infections by making it easier for bacteria on the perineum (the area around the anus and between the anus and genitals) to swim up the urethra into the bladder. If he had a bacterial infection in his intestines at the time he took the bubble bath, these same bacteria could have caused his urinary tract infection.

Sincerely,
Dr. Warren

After checking your previous subjects this did not appear so your response would be much appreciated.

Thanks in Advance

-KA

Dear KA: An umbilical hernia is an opening in the connective tissue between the abdominal muscles at the navel which allows abdominal contents (the fat pad covering the intestine in this location) to protrude through. The navel is a common location for a hernia because there was a natural opening there through which the umbilical cord blood vessels passed. After the cord falls off and the vessels shrink the opening is supposed to close. If it does not close completely, there is an umbilical hernia. Umbilical hernias may close on their own without surgery and often do by 3 years of age. Those that do not close by 3 are unlikely to close without surgery.

Umbilical hernias rarely cause any symptoms, and since the intestinal fat pad covers the intestine by the navel, there is little risk of the intestine passing through the opening and getting caught which is the problem with other hernias. Unless the hernia is causing abdominal pain (pain at the location of the hernia) it doesn't require repair except for cosmetic reasons.

Other than surgical repair or leaving it alone, there is no treatment for an umbilical hernia.

Sincerely,
Dr. Warren

-PP

Dear PP: The salutation in your e-mail to me said, "Dear Dr. Suser," so I'm not sure if you're referring to advice you read at Dr. Suser's Web site, or something you saw on "Ask Dr. Warren."

Using time-out as a very effective means of dealing with tantrums, but even time-out behavior must be learned. A two year old has a short attention span, so his time-outs must be short with ample opportunity for him to rejoin the group at the first sign of acceptable behavior. By not being overly strict about the manner in which time out is applied, the young child can learn to succeed at time-out.

The circumstances of a tantrum will necessarily affect how a time-out is instituted. One of the basic tenets of dealing with tantrums is to ignore them until they are over, which is best accomplished by putting a child in time-out or walking away from him. But on the other side of the coin is the fact that parents must be able to adapt their response to a child's needs and the unique circumstances of the situation while maintaining some consistency of response. There are times when the location of the tantrum (a public place, a home other than your own) will affect your response. And there are times when your child's emotional state will affect your response. There are times when it is clearly appropriate to comfort your child and deal with the behavior later. Only you can decide which circumstance you're dealing with. What's more, even when you feel a time out is justified, calming your child before you put him in time out may sometimes be appropriate.

I'm a big believer in avoiding tantrums when possible by distracting children from their mischief to direct them toward more appropriate or acceptable behavior. This definitely does not mean giving children their way to avoid tantrums or not enforcing rules, but it does mean not overwhelming little children with temptations they can't handle and a litany of rules so extensive that they're always likely to be breaking at least one. Children love to please their parents. We have to make it possible. Please read my article, Managing the Difficult Child: Toddlers

Sincerely,
Dr. Warren

He also recently had a large, what looked to be, a pus pocket on his tonsill. A familly member who's in familly medicine looked at it and said it was a tonsillar crypt. We drained it over a period of days and now there is just the hole or pocket left in the tonsill. He gargles to keep it clear. Now I'm trying to find information about this "crypt". How did it get there? Will it heal? Is there more to this condition? Please share any info you may have! I am worried.

Thank you very much! I look forward to hearing from you.

-Heather

Dear Heather: Subnormal temperatures may be seen with infection, but the tympanic reading may be falsely low if the thermometer is not aimed properly at the ear drum. This is the more likely explanation.

Crypts are normal crevices found in tonsils. Larger and more inflamed tonsils have larger crypts in which debris may get caught. What you describe is an enlarged tonsillar follicle, not a crypt. The follicle forms in response to inflammation as with sore throats. Large follicles may leave a hole in the tonsil which will eventually fill in. Sometimes people may experience recurrent follicles. They are not harmful or worrisome. Gargling is fine.

Sincerely,
Dr. Warren

-JM

Dear JM: The sleep habits of adolescents are related to social and psychological changes of growing up rather than biological. As children they always knew that night time was for adults. As they enter their teens and are allowed to stay up later they become aware of more adult entertainment on TV late at night and dance clubs and other social activities which don't begin until late and end late. At the same time, they discover that night time is their time since their working parents are often ready to go to sleep before they are. In addition, they tend to stay in bed when they have nothing to do, nothing to do being defined as their friends are not available. With few exceptions, things the family is doing or chores that you want done do not constitute something to do.

As their own lives begin again to mirror the real world with family and job responsibilities, many will find more normal hours, but it is at this time when sleep habits become independent of parental regulation that some teens discover they are night people rather than morning people.

Sincerely,
Dr. Warren

-Disgruntled Teen

Dear Disgruntled Teen: Chicken pox should form all over the body rather than in one localized area. If you previously had chicken pox and the lesions you have look somewhat like chicken pox, you may have shingles, which is a reactivation of chicken pox virus that is lying dormant in a nerve root. Because the shingles come out along a nerve they can often cause pain or burning rather than the typical itch of chicken pox.

Since I haven't seen your rash, I can't tell you what it is. If it is spreading, it could be a skin infection like impetigo. The best way for you to know what it is, and get appropriate treatment, is to see a doctor.

I applaud the efforts of any teen who wishes to take care of his own problems instead of turning to his parents for everything; however, being independent also means knowing when you need help and knowing to whom to turn for help. I'm sure your parents would want you to see a doctor for this rash. The first thing to do, is show your parents what's going on.

Sincerely,
Dr. Warren

-DC

Dear DC: 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

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