10 May 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
How common is this and what are the possible reasons for unexplained stillbirths. My OBGYN said it is 1/1000 for unexplained stillbirths, what do you think?
Regards,
-SK
Dear SK: The major causes of still birth are related to infection, prematurity, congenital anomalies, and placental problems such as placental abruption. With regard to stillbirths, in the vast majority of "normal" babies delivered at term, no cause of death is found. There have been instances of twin pregnancies where there is a fetal demise of one twin and the second twin is healthy at delivery. Intrauterine asphyxia (anoxia, hypoxia) because of placental insufficiency, abruption, or compression of the umbilical cord is certainly a possibility. I have no figures on the frequency of these stillbirths and would be inclined to agree with your ObGyn's experience.
My condolences on your loss. Your pain will decrease with time, and even though having a healthy baby will not make it like you never suffered this loss, you should take heart in knowing that, since nothing was found, your likelihood of having a healthy baby is good.
Sincerely,
Dr. Warren
-MS
Dear MS: There is very little growth of the penis during childhood until after puberty begins. The first sign of puberty in a boy is enlargement of the testicles. The penis doesn't start to grow until a little later. The average age for male puberty is around 13. Some boys start puberty earlier, but many don't start until later. From what you have told me there is no need for concern about the size of your 12 year old's penis.
Sincerely,
Dr. Warren
We have a six year old son who has the following characteristics:
-MKZ
Dear MKZ: Both your children are quite large for their age, but your 6 year old's weight is considerably above the range expected for his height. This can make the penis appear smaller since it may be buried in the pubic fat pad. There is a considerable range in normal size for children's (and adults') penises. Since I haven't examined your child, I can't comment on the normalcy of the size of his penis, but if there were anything unusual about it, by six years old I would have hoped you and his pediatrician would have discussed the matter. In any event, there is no relationship between the size of the penis and the ability to stay dry at night.
Since your six year old son has normal daytime bladder control, the innervation to the area is normal, therefore, the fact that you have not noticed any erections has no significance with regard to his staying dry at night. Some boys have more erections than others. Your six year old has most likely had erections of which you were not aware.
Your six year old is larger than your two year old. It is perfectly reasonable for the six year old to wet his diaper more.
Since I haven't examined your son, I can't state with certainty that there are no hormonal problems, but you have not described anything that would make me think of a hormonal abnormality. Many children still wet their beds at six.
Night time wetting occurs during sleep. It is not under voluntary control. It is related to central nervous system maturity. Most children who are dry during the day will eventually become dry at night without any intervention. There are treatments for those children who continue to wet. For additional information read my article, "Bed Wetting" at http://www.mindspring.com/~drwarren/enuresis.htm.
Sincerely,
Dr. Warren
-Concerned Mother
Dear Concerned Mother: When a baby spits up or vomits it may sometimes come up into the nose since the nose and throat are connected. To decrease the likelihood of this happening, make sure your baby has burped after a feeding before you put her down in her crib. It may also help to hold her upright for a longer time after feeding before you put her down. Using a bottle system with a collapsible bag like the Playtex Nurser may also help by decreasing the amount of air swallowed.
If your baby is vomiting a significant amount after each feeding, you should reveiw her weight gain with your pediatrician and advise him of her degree of vomiting so that he can determine if there is a cause for concern.
Sincerely,
Dr. Warren
-RN
Dear RN: Inability to breathe through the nose and recurrent ear infections can both be caused by enlarged adenoids. Loud snoring with periodic stops in breathing (sleep apnea) can be caused by upper airway obstruction form enlarged tonsils or adenoids. You should have your daughter evaluated by an ENT surgeon. She may benefit from having her tonsils and adenoids removed if they are enlarged and causing the symptoms you describe.
Sincerely,
Dr. Warren
Thanks!
-Audrey
Dear Audrey: The letter your nephew's parents should write depends on what degree of authority they wish to grant you. If they are reachable by telephone, they might want to give you permission to seek emergency medical treatment and give you power of attorney to make all medical decisions if they can't be reached or if taking the time to reach them carries a significant risk. As long as they are reachable, they should be contacted for any procedures that require consent such as surgery unless the delay in treatment would be risky.
You could try a letter like this (words in parentheses can be substituted for the words preceding them):
I, __[parent's_name]__, parent (mother or father) of __[child's_name]__ , hereby authorize ___[aunt's_name]__ to seek and give consent for medical treatment for my son __[child's_name]__ . In the event that specific consent is needed for any procedures, I can be reached at __[telephone_number]__ . In the event that I cannot be reached or delay in treatment poses any risk to my son, __[aunt's_name]__ has full authority to give consent for any and all procedures.
__[parent's_signature]____
Fill in the blanks with the appropriate information as indicated in brackets. Be sure to have the parent's signature notarized.Since I have no legal training, if there is any doubt, review the letter with a lawyer.
Sincerely,
Dr. Warren
-Ray
Dear Ray: Sometimes subnormal temperatures may be seen instead of fever when a person is ill, but even with a fever, it is possible for a child to feel cool to the touch. When the body temperature is rising, the body conserves heat by decreasing blood flow to the skin. This can result in the skin feeling cool to the touch. When the temperature is on it's way down, the skin may become flushed and feel hot. After the temperature has come down, the skin may feel clammy from sweating and may again feel cool, even if the temperature has not gone all the way down to normal.
Sincerely,
Dr. Warren
Thanks for any advice or direction to reading material.
-Z
Dear Z: Scabies may be difficult to tell apart form eczema or a contact dermatitis since a good portion of the rash is a reaction to the mite rather than the burrows in the skin. The thing that helps in making the diagnosis is the characteristic distribution. The rash of scabies is found primarily between the finger webs, under the arms, at the waist band, and in the genital area.
Since the rash results from a reaction to the mites, it can take up to a month after infection with scabies for the full rash to develop. If you do have scabies, this could explain why other family members have not yet shown signs of having it.
Dust mites are microscopic. They feed on dead skin cells that have been shed by humans. They do not bite.
There are other treatments for scabies such as crotamin and lindane, so if the Elimite hasn't helped, your doctor could prescribe other medication; however, if there is any doubt about the diagnosis, perhaps you should see a dermatologist before embarking on another course of treatment.
Sincerely,
Dr. Warren
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