21 June 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
-CW
Dear CW: What you describe as retraction of the penis is simply a penis buried in a large pubic fat pad. The penis is not retracted or "in". When the size of the fat pad decreases the penis will become more visible. This generally occurs during the toddler years, but if the child is overweight, the penis could continue to appear buried in the fat pad until puberty.
Sincerely,
Dr. Warren
-Joanne
Dear Joanne: Fluid on the brain is known as hydrocephalus. A head that is larger than normal is not necessarily hydrocephalus. The diagnosis can be confirmed by doing a CT scan of the head. Hydrocephalus must be treated surgically by placing a shunt to remove fluid from the brain. With treatment, the child should do fine, but without treatment a child with hydrocephalus will suffer progressive brain damage.
Sincerely,
Dr. Warren
Thank you
-Paul
Dear Paul: In order to be sure that we are talking about the same thing, I believe that what you call glandular fever is what we call mononucleosis in the USA. Mononucleosis spreads through secretions, primarily saliva and mucus. It spreads through close contact, or sharing food, drink, and utensils. There is no cure, but it runs it's course and resolves completely. The acute course runs about two weeks, but it can leave the patient fatigued for up to 1 year.
Sincerely,
Dr. Warren
Thank you for your time.
-CG
Dear CG: Whether or not you should be concerned about your enlarged lymph node depends on where it is and how large it is. Colds can cause lots of little lymph nodes in the neck, but in the absence of recurrent upper respiratory infections, these nodes should generally shrink down again. Three months is a long time for an enlarged node to stick around in an adult. When in doubt, check it out. You shouldn't be alarmed, but you should check it with your doctor.
Sincerely,
Dr. Warren
Have you ever heard of this happening before? Our doctors are wonderfully professional people but they just shrug their shoulders. I'm afraid it will happen to another family.
-(unsigned)
Dear Gieving Parent: I have never heard of a situation where a child bled through his mouth recurrently. I cannot say it is in any specific way related to Down's Syndrome or AV canal, since physicians have extensive experience with both, and I don't believe your situation has been described.
I have had situations where children bleed from the mouth and the source of the bleeding is not evident, but if this were recurrent, I would hope the source could be found by doing a complete ENT exam including looking at all the hidden tissues with a scope. If there were one source of bleeding in your child, it should have shown up on autopsy. If there were severely congested tissue which exuded blood, I suppose the congestion could have resolved before the autopsy.
I am sorry for your loss. I wish that there were more I could tell you.
Sincerely,
Dr. Warren
-PK
Dear PK: There are two basic types of medications used for treating asthma: anti-inflammatory medications which reduce the inflammation in the airways that provokes the wheezing, and bronchodilators which reduce the spasm in the constricted airways. Short acting bronchodilators are used as rescue medications because they open up the airways quickly and provide symptomatic relief, but in chronic or moderate to severe asthma, rescue medications are not sufficient treatment because the wheezing will keep recurring. To prevent this, maintenance medications are used. Maintenance medicines include anti-inflammatory medications and long acting bronchodilators.
Both rescue medications and maintenance medications are available as sprays. Some medications are available as oral (syrups, capsules, tablets) as well. Any medication that is use as a spray or through a nebulizer goes directly into the lungs allowing lower doses to be used with less side effects than if the medication were taken by mouth or injection and had to go through the whole body before it gets to the lungs.
Sincerely,
Dr. Warren
Information?
We have a 23 month old boy who over the last few months has been continuosly experiencing a high fever, runny nose and flu like symptoms. He has been going to a daycare facility 3 times a week (since he was one) and our pediatrician tells us this is normal and he is building up his immune system (exposure at daycare has brought this on). Could there be any other reason?
He had pneumonia at 14 months, and at least 3 ear infections since then. he only goes two or three weeks at most without having problems. For the past 4 days he has been up and down on the fever chart, 104.5 just last night.
We are worried that there may be something else going on that we are not aware of. I'm not sure that you can help, but I'm looking for some type of info. or reassurance.
Thank you in advance for your response.
-NL
Dear NL: It can be very frustrating when a child is constantly ill with infectious diseases; however, this occurs with some regularity with children in daycare because of their high degree of exposure to infectious illnesses. Unless a child has unusual infections, or his infections run an unusual course, the frequency of these infections does not generally imply anything about the child's general state of health other than that he has a high rate of exposure to infection.
The average child has 6 to 12 upper respiratory infections each year. Some children just tend to get sicker with these, running fevers and having complications like ear infections. The tendency to have multiple ear infections is related to facial structure and middle ear congestion rather than any difficulty fighting infection.
Other parameters that can tell you if your child is basically healthy include his growth rate, appetite, and social and intellectual development. If your pediatrician's assessment of his health is that he is fine and he recovers from all his ills without consequence, there is little cause for concern.
Sincerely,
Dr. Warren
| Birth | 7 lbs, 10 oz | 19.5 in |
| 2 wk | 9 lbs, 1 oz | 20 in |
| 6 wk | 11 lbs | 22 in |
| 3 mo | 13 lbs, 4 oz | 24 in |
| 6 mo | 16 lbs | 26.25 in |
| 12 mo | 17 lbs | 29.25 in |
| 15 mo | 18 lbs, 12 oz | |
| 18 mo | 19 lbs, 12 oz | 31.5 in |
His pediatrciian was extremely alarmed at his 1 year appointment. Blood tests for thyroid function and blood count, urinalysis and sweat test (sodium) were performed and came back normal. (A doctor's note for HC 44 CMS is written on the blood test sheet, if that helps.)
Currently, he eats well. Breakfast-2 5 inch pancakes, bites of cereal and some fruit. Lunch-half a sandwich or 1 hot dog or 5 small fish sticks, 4-6 oz yogurt, fruit. Good snacks-cheese, crackers, fruit.
I would like to know if there are other tests you could recommend for my son to determine why he is not putting on the weight. I realize that he may be small for the rest of his life but I want to exercise all my options.
Thank you for any input you could give us.
-Ann
Dear Ann: Your son's height has been steadily in the 25th percentile. This is well within the normal range. Therefore, your son is not small. He is thin. Since his linear growth (height) has been steady and satisfactory, the focus should be on his nutritional status rather than possible causes of growth failure.
The first thing to look at is your son's intake. You should consult a nutritionist and review your son's diet in detail to determine if it is adequate. A high calorie supplement like Pediasure may help.
Next your doctor should evaluate for abnormal losses by reviewing bowel habits and any history of vomiting. A stool analysis may be necessary to check for abnormal caloric loss due to malabsorption. The urinalysis has already been done.
Sincerely,
Dr. Warren
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