26 April 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
-PP
Dear PP: There is no great cause for alarm about your son's increased use of the bottle. It does not imply any emotional problem and need not interfere with his nutrition. However, at an age when most infants should be getting near the point of eliminating the bottle completely, it is definitely a step backwards. Sometimes it is hard to move children up to the next developmental stage because parents miss the perfect opportunity. Since he managed all this time without daytime bottles, he should not need them now. It is not harmful, but it is unfortunate if you have started giving him the daytime bottles again. I would not allow him to increase his dependence on the bottle further at this point, and would start to phase them out again in the near future.
Sincerely,
Dr. Warren
-KR
Dear KR: Information about vaccines is available on-line from the CDC. To view information about the MMR go to the CDC Web site.
The MMR vaccine is a live virus vaccine. It can cause most of the same symptoms that would be seen with the infection it is supposed to prevent. The mumps vaccine can lead to salivary gland swelling. The rubella vaccine may result in swollen lymph nodes. Any symptoms which persist beyond the length of time one of these illnesses might last (longer than a week) should make your doctor think of other possible causes.
Sincerely,
Dr. Warren
Sincerely,
-ES
Dear ES: If your niece screams after every feeding, a trial of a hypoallergenic formula such as Nutramigen or Alimentum might help. If not, she should be evaluated for gastroesophageal reflux which could be causing her distress after feedings, especially if she is lying down. For further evaluation you could consult a pediatric gastroenterologist.
Sincerely,
Dr. Warren
Sincerely,
-Kat
Dear Kat: Knowledge is power. The best way for you to decide how to handle your problem is to get knowledge about marijuana use. The following Web sites provide some excellent information:
The NIH site listed above provided this answer to the question of whether or not marijuana is addictive.
"Yes. While not everyone who uses marijuana becomes addicted, when a user begins to feel that he or she needs to take the drug to feel well, that person is said to be dependent on the drug or addicted to it. In 1993, over 100,000 people entering drug treatment programs reported marijuana as their primary drug of abuse, showing they need help to stop using.Marijuana is considered a gateway drug to hard drugs. While not every marijuana user will go on to hard drugs, marijuana increases the risk of using other drugs significantly because those who tend to use marijuana are more likely to engage in risky behavior, they have a higher risk of psychological dependence on getting high, and their social circle changes to a drug using crowd. The same risks apply to teenage use of alcohol. Most teen alcoholics or drug users never intend to become dependent on drugs. Whether they try it for a lark or choose it as a means to dull the pain of their existence, few consider that they might get sucked in deeper and deeper and the drugs would ultimately become their biggest problem.Some heavy users of marijuana show signs of dependence because when they do not use the drug, they develop withdrawal symptoms. Some subjects in an experiment on marijuana withdrawal had such symptoms as restlessness, loss of appetite, trouble with sleeping, weight loss, and shaky hands."
Friends of drug users who wish to save their friends walk a fine line between helping their friends to quit and enabling their friends' habit. The truth is that quitting can be hard, and unless a user wants to quit, he often can't see that the pain of using is worse than the pain of quitting. If their friends make it clear that they will be there when the user comes to his senses, that can help. But standing by a user no matter what and being dragged down by him can just make it easier for him to continue his self destructive behavior.
You must be realistic. You don't have the power to make your friend stop. And if you're by his side when he gets caught selling pot, the police won't care what your intentions are. Tell your friend that you love him. Tell him that you'll be there for him. And tell him that you won't participate in his self destructive behavior and that you won't let him drag you down with him. Tell him it's his choice. And then be prepared to walk away from him until he's capable of seeing what he will be losing if he loses you. Risking your friendship may be the best way to bring him to his senses.
You sound like a special person. It's admirable that you want to help your friend. Sometimes, when you're 14, it's tough to find an adult you trust and talk to him. Adults can sometimes be so judgmental. And once the lecture begins, they don't hear a word you're saying, and they don't focus on helping you. Or so it seems. Maybe, sometimes they just tell truths that you really don't want to hear. But the truth is, there are a lot of adults out there who love and admire teens and realize that today's youth are our future. This problem is too big for you. Don't try to deal with it alone. Join a school group like SADD. Talk to a school counselor. Talk to your parents. Talk to your priest or rabbi. See if you can get a program organized in your school or community to talk to you about drugs. Get help to make sure all your friends are there, including your pot smoking friend.
Sincerely,
Dr. Warren
My question is two-fold. First, what kind of evidence should I require to understand if further x-rays are really necessary? Second, what is the risk of additional x-rays to my daughters growing organs? I would appreciate your input.
Thank you.
-LR
Dear LR: All radiation is cumulative over a life time, and that is especially true for sensitive tissues like the reproductive organs. For that reason, it is wise to avoid any unnecessary x-rays. Even so, you should also be aware that the amount of radiation in a single x-ray study of the hips does not pose a significant risk to the ovaries. If an x-ray is medically necessary, there is no reason to avoid it.
Shielding is an excellent way to protect sensitive tissues; however, if the shield blocks the view of the area in question, then shields cannot be used. If the place where the head of the femur goes into the acetabulum is obscured by the shield, then the study is inadequate.
The first thing you should do is see if you can speak to the radiologist who reviewed the x-rays and ultrasound studies to find out whether or not these studies are adequate to rule out acetabular dysplasia (congenital hip dislocation). If possible, have the studies reviewed by a pediatric radiologist. Not all radiologists have experience interpreting ultrasound studies of the hips. Finally, you should consider consulting a pediatric orthopedist for an examination and review of the films in order to determine if more needs to be done.
Sincerely,
Dr. Warren
thank you
-RD
Dear RD: Most croup is caused by an upper respiratory virus which has it's peak season in the fall. Unlike a cold, the inflammation is in the throat around the entrance to the trachea, rather than in the nose. The inflammation around the entrance to the trachea results in the characteristic barking cough. If there is enough inflammation of the trachea, the narrowing of the trachea causes a relative upper airway obstruction which results in stridor (a crowing noise as the patient breathes in). If the stridor increases the breathing becomes labored. For more information you may read my article, Croup.
Sincerely,
Dr. Warren
Sincerely,
-VF
Dear VF: If your son's bowel movements have remained soft, and he is not distended (swollen belly) or complaining of abdominal pain, if his appetite is good, and the bowel movements are a reasonable size, then there is no cause for alarm. Since you describe some stool withholding behavior, a lubricant like mineral oil given by mouth can make it harder for him to withhold stool and result in more frequent BMs. I can't find a listing for the ingredients in Fletcher's Castoria, but if my memory serves me correctly, mineral oil is the main ingredient.
If your son is having very small bowel movements, even if they are soft, it is possible he may have a rectum full of hard stool. Your doctor can determine this by doing a rectal exam. If your son's rectum is full of hard stool, he may need an enema to empty him out before the lubricant can work.
Sincerely,
Dr. Warren
-AA
Dear AA: The American Academy of Pediatrics recommends not introducing solid foods until babies have adequate head control and swallowing control for spoon feeding. This is not before 4 months. From a nutritional standpoint, there is no need to introduce solids before 6 months. Formula or breast milk is a complete and balanced food. Solids are NOT more filling. If you've ever had a baby spit up on you several hours after a feeding you can see that the protein portion of the feeding is curdled and solid. In the early months a baby's needs should be met quite adequately with formula or breast milk alone. If the baby is hungry that means it needs more milk.
Early introduction of solids increases the risk of allergic reactions, but other than that and the issues discussed above, there is no risk of harm to the baby from early introduction of solids. Still, if the baby were my patient, the mom would be strongly advised to discontinue the solids.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
