24 May 1999

1. When Another Child Hits Your Child
2. Dogs & Babies
3. Dairy & Ear Infections
4. Mother Doesn't Care Properly for Baby
5. Pyogenic Granuloma
6. What to Do With a Vomiting Baby
7. Red Blood in Infant's Stool
8. Use of Asthma Sprays
9. Disclaimer

• Read Questions & Answers in Another Column

When Another Child Hits Your Child

-KA

Dear KA: It is always difficult when you disapprove of the behavior of another child and by implication the child rearing practices of his mother. Mothers are very sensitive about such issues. It is even more difficult when the other mother is someone you're close to. But the only resolution to your problem is to continue what you're doing (which is no solution), to keep the children apart, or to come to an agreement with your sister. I think you can see that I'm leading you to realize that you and your sister must talk and work out an agreement. The point here is that you are working on an agreement about how to deal with a problem that has arisen between your two children. You are not trying to tell your sister how to raise her child. In fact, you may not care how she raises her child, but you have every right to discuss how your child has been affected by the hitting problem and what possible solutions there are to the problem. Just remember that a discussion involves listening as well as talking. When you present the problem to your sister you should be prepared to listen to her ideas for a solution before you present your ideas. Try to arrive at a compromise, even if it isn't exactly what you feel should be done.

Sincerely,
Dr. Warren

Since the dogs do not bring in ticks, only the occasional flea, I am of the opinion that they will not be much of a risk for transmitting disease. I feel that most of the colds and diseases the infant will get will be transmitted by us humans. What is your opinion in this matter?

Sincerely,
-BR

Dear BR: You are correct that most human diseases are spread from human to human rather than from animals. Human upper respiratory viruses do not affect dogs and cannot be carried by dogs. Dogs can carry bacteria in their respiratory tract and so they can carry streptococcus; however, a dog who is carrying strep has most likely picked it up from his human companions.

Overall dogs do not pose a major health risk to babies; however, it is important to realize that no matter how beloved your dog is, he is a dog, not a human. He understands the world like a dog and responds to it with dog instincts. While most dogs are extraordinarily protective of the babies they are brought up with, there are some potential risks when the new baby enters the dog's territory. No infant should ever be left alone where it can be reached by a dog. The dog's response to the infant's movements and cries are unpredictable. The dog and infant should be regularly exposed to each other in the presence of the adults so that they can get to know each other safely. This would be difficult to accomplish if the dogs are kept apart from the baby for two years. Since toddlers are very mobile and capable of doing things that could provoke a dog, it would be best if the dogs and baby had a relationship before the baby's toddler stage.

Sincerely,
Dr. Warren

I am very concerned and am not sure what to do. Could it be allergies? I have heard that dairy products can contribute to ear infections. She eats almost solely yogurt, cheese and milk. Is this a possibility? I am really confused because for the first year, she was not sick one time. Are these solely because she entered daycare? And lastly, I have been told that chronic ear infections can destroy the mastoid and cause hearing loss. What is the mastoid, and how many infections does it take for hearing loss to occur.

Should she be seen by an allergist, by an ENT doctor for a second opinion?

Please advise.

Thanks so very much.

-KB

Dear KB: Allergies of any sort, including allergies to dairy, may contribute to congestion of the middle ear and therefore ear infections. For some reason, the idea that allergy to dairy causes ear infections is extraordinarily popular among nonmedical people. I have published several letters on the subject on my Web site which you might enjoy reading. You might also find my article, Another Ear Infection!?!, enlightening.

As to whether or not milk allergy is contributing to your child's ear infections, unless your child began to consume dairy at the same time she entered daycare, since the ear infections began when she entered daycare, they are most likely the result of a high frequency of colds caught in daycare. As you think about this, remember that if your daughter was on a milk based formula like Enfamil or Similac, her exposure to cow's milk began in early infancy. If you consider the information I have given you and think that milk allergy may be the culprit, you can try your daughter on a milk free diet to see if the situation improves. Just keep in mind that dairy is an excellent source of nutrition, so you will have to find suitable non-dairy substitutes.

The mastoid is the bone behind the ear. The treatment of ear infections with antibiotics has gone a long way toward preventing mastoiditis. Even if your child has a high frequency of ear infections, she should not suffer any permanent damage if the infections are controlled by the antibiotics. If your daughter has persistent middle ear fluid, this can interfere with hearing. The effect of middle ear fluid on hearing is temporary, but if it persists for a long time while a child is developing language, it may result in language delays. If the infections are not controlled by antibiotics or your daughter has middle ear fluid persisting for more than 4 to 6 months, you should consult an ENT surgeon.

Sincerely,
Dr. Warren

Thank you for your help.

-BS

Dear BS: Pediacare is made by the same company as Tylenol and the dosage is the same as Tylenol drops. If the baby is over 13 pounds (as most 6 month olds are) 0.8 ml. is an appropriate dose. When I counsel parents about children's cold medicines I always try to help them understand that cold medicines don't cure colds. The purpose of a cold medicine is to provide symptomatic relief. That means that you don't give a child a cold medicine just because he has a cold. Rather, you give cold medicine if the cold is bothering the child. Cold medicines can make babies cranky or sleepy. Pediacare is a decongestant which has stimulating properties. Other than making the baby cranky this should have no ill effect on a healthy baby and no long term effects. You should be aware that many physicians are quick to offer medication when parents call for advice, so it is possible that the infants doctor advised her mother to give the medication without making clear that it was for symptomatic relief only rather than a necessity. Many parents believe that medicine is necessary for treatment of a cold, and Pediacare drops are marketed for infants.

There is plenty of evidence that second hand smoke is bad for kids and results in an increased frequency of respiratory infections and asthma, but plenty of good parents who are addicted to nicotine, smoke in the presence of their children.

I think you have real concerns about your little cousin and you have the best of intentions, but I have to caution you that if you question everything the child's mother does and assume that it is potentially abusive, you run the risk of alienating the mother. In addition, if you make an issue of every small matter, including things like the Pediacare situation, you may not be listened to when it really counts. Based on the little you've told me, it sounds like this mother really needs to learn about proper parenting. If you hope to help your little cousin, your best bet is to become a friend to the mother who can then turn to you for advice. If you come across as distrusting everything the mother does and trying to catch her doing wrong things to her child, she has no choice but to become defensive.

If you want to give your cousin, the baby's father some good advice, tell him to become more involved in his daughter's life. When the child is sick or even when she goes to the pediatrician for well care, he should accompany the baby and her mother to the visit. That way he can ask questions and hear the pediatrician's advice himself. He shouldn't be in the position to have to choose between your advice or the advice of other family members and friends and what the baby's mother tells him the pediatrician says.

The thing that would be best for the baby is to help her mother be a good mother and to have two parents actively involved together in her life.

Sincerely,
Dr. Warren

-FD

Dear FD: A pyogenic granuloma can result from trauma, even minor trauma. It is not dangerous. It consists of granulation tissue which is growing through the skin. Granulation tissue forms the basis for internal scar tissue formation. Normal skin may develop over a pyogenic granuloma leaving a small bump. If a pyogenic granuloma is large or repeatedly traumatized, it should be removed. I cannot think of a reason a child should have multiple pyogenic granulomas. Most children will never develop one. If your child has a pyogenic granuloma, there is no reason to expect Benadryl to help. You should see a dermatologist for diagnosis and treatment.

Sincerely,
Dr. Warren

I have 11 month old twins, born healthy but small at 33 weeks gestation. They went to a playgroup on Friday where I spotted a few runny noses (I know, I know...). This morning I heard a few coughs and a little phlegm, then saw some runny stuff. No big deal; I learned my lesson. Then my daughter threw up her breakfast of oatmeal and fruit-- still, not so scary-- no temp, in good spirits. An hour later she threw up her bottle. Now, what should I do? Do I need to take her in somewhere? Should I try to feed her lunch later? If so, what?

Thank you very much for responding as soon as possible.

-BN

Dear BN: It is well past lunch time, so I hope my response is still useful to you. Unfortunately I cannot check or respond to e-mail more than once or twice a day.

If a child has severe abdominal pain or persistent symptoms, he needs to be seen by a doctor. If the vomiting does not appear to be associated with other worrisome symptoms, an effort can be made to control the vomiting at home before calling the doctor. When an infant (or any person) is vomiting, no matter what the cause, the first priority is to prevent dehydration. To accomplish this, the first step is to put the stomach to rest, so all food must be stopped. A child can manage without food for a few days if necessary, and feeding a vomiting child doesn't nourish him since he can't retain the food. A child may vomit multiple times until his stomach is empty of all food. Once the vomiting has stopped for at least an hour, then an attempt should be made to start giving the child small amounts of clear fluids.

Clear fluids can include clear juice like apple juice, flat soda (completely flat), and weak decaffeinated or herb tea, but the preferred fluid is an electrolyte solution like Pedialyte. The clear fluids should be given first in very small amounts and then gradually increasing amounts. If the clear fluids cannot be tolerated, you must seek medical attention. For additional information read my article, Management of Gastroenteritis.

Sincerely,
Dr. Warren

Are there any particular ideas as to diagnosis, suggestions for tests, or physicians in the West Palm Beach Florida area you could recommend? My sister only recently moved to Florida.

Thank you.

-MS

Dear MS: Bright red blood may be seen on the stool if a baby has an anal fissure. A fissure may be visible on physical examination by your doctor. Red blood may also be noticed in stool when a baby is allergic to his food, but that would be extraordinarily rare in a nursing baby. Juvenile polyps may bleed resulting in red blood in the stool. Probably the best way to find out is for a pediatric gastroenterologist to look inside with a special scope.

I regret that I know few physicians outside the area of my practice in south western Long Island. I cannot offer any recommendations for physicians in Florida.

Sincerely,
Dr. Warren

-K

Dear K: Asthma sprays are not addictive. They do not cause dependence. Asthma is a chronic condition. Since it is a chronic condition, some asthmatics have frequent symptoms for which they require treatment, and so they take their sprays regularly. Their regular use of the spray is as a result of their recurrent symptoms and not the cause of their symptoms.

If your child wheezes occasionally and it stops spontaneously, he can manage without any treatment if the symptoms are not bothersome to him. But if the wheeze is more severe or persists, there is a risk that he will go into a full blown asthma attack with difficulty breathing if he is not treated. If your son limits his activity because of wheezing, he should have the benefit of medication.

The course of asthma is unpredictable. Some children will "outgrow" it in early childhood or adolescence. Others will remain symptomatic even as adults. Treating him with a spray will not influence whether his asthma persist into adulthood. Avoiding the spray cannot prevent the persistence of his asthma. The spray is the best medicine to relieve asthma symptoms. If your son needs relief of symptoms, he should use it. If he has persistent symptoms, you should discuss anti-inflammatory sprays with your doctor.

Please read my five part series on asthma available at http://www.mindspring.com/~drwarren/.

Sincerely,
Dr. Warren

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