2 August 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
Also what are the abnormal sign associated with pathological murmurs in children?
-CC
Dear CC: A child with hypospadius has the urethral opening somewhere along the underside of his penis rather than at the tip of the penis.
A pathological murmur is diagnosed by either its harsh quality, long duration, location, or presence in diastole since innocent murmurs occur only during systole. Other signs associated with pathological murmurs depend on what kind of cardiac defect is associated with the murmur and whether the patient is in congestive heart failure due to the defect. These signs could include cyanosis, tachypnea, tachycardia, hepatomegally, hypertension, or abnormal pulses.
I have not gone into great detail explaining these signs since I don't know your level of medical knowledge or your reasons for asking these two seemingly unrelated questions. If you need more of an explanation, please write back with a more specific question, or ask for an explanation of any terms I have used with which you are unfamiliar.
Sincerely,
Dr. Warren
-M
Dear M: According to the PDR Ritalin SR must be swallowed whole and never crushed or chewed. If your son cannot swallow them whole, you and your pediatrician should discuss switching him to the short acting preparation twice daily or consider Dexedrine Spansules.
Sincerely,
Dr. Warren
My question is: is there not a medicine for children's/infants' diarrhea? Doctors here do not give babies drugs to stop the diarrhea. It is frustrating as I see my son in bad shape and all I can do is just give him Pedialyte and nothing to ease the discomfort that he must be feeling.
Please let me know if this is practiced in mainland USA. I live in Saipan and do not know if this is really a usual practice in the entire country.
Thank you very much.
Truly yours,
-BB
Dear BB: The goal in managing diarrhea in infants is to prevent dehydration. There are no medications which accomplish this. If a sick infant can retain enough electrolyte solution such as Pedialyte, that will prevent dehydration. There are no medications which shorten the course of infectious diarrhea. The diarrhea results from inflammation of the intestine from the virus infection. After the body rids itself of the virus, the intestines must heal before the diarrhea resolves. Medications which are used to relieve symptoms in older children or adults have no role in the management of diarrhea in infants. They do not prevent dehydration or alter the course of the illness. In addition, the most effective symptomatic medications such as narcotics and Imodium increase the risk of an infant becoming sicker by developing an ileus, a situation where the movement of the intestines stops. While this will result in the infant not passing bowel movements it also is a form of functional obstruction which will result in the intestines filling with the inflammatory fluid that would have been passed as diarrheal movements. For a complete discussion of the management of diarrhea and vomiting read my article, Management of Gastroenteritis.
Sincerely,
Dr. Warren
I am not doubting the word of two doctors, one of which is his aunt and Godmother, it's just that they don't live with him. All he wants to eat is rice. He used to be such a good eater. His usual intake of food is a bottle in the morning, maybe 1/2 a bagel for breakfast and about 4pm he'll accept some rice and then of course his nightime bottle. During the day he'll much on Cheerios, crackers, milk/water. I've tried everything to get him to eat. I, however, don't force him. When he was eating, he ate practically everything, some fruit (not all), vegetables (in soup of with poultry or meat), breakfast was always good. In essence, I felt good because I was successful in giving him a well balanced and healthy meal. Even when he snacked, he used to snack on fruit. I know I should be thankful he is healthy and I am, believe me. I know people are right when they say I am the typical over-worried-first-time-mother, but I can't help wanting my son's good health to continue. Although I am aware he will get sick from time to time but like I said, I can't help it.
Please help me, I'm a loss and I cry every time another day goes by and all he wants to eat is rice. I do make other things to go along with rice but he won't take it.
Another thing is that at a recent doctor visit a did not have his regular doctor. The doctor that saw him told me that I should "break his spirit" to get him to eat what I want. I strongly disagree with this, my son is not an animal! I was very offended at this suggestion. There has to be another way. He is a very good little boy and very loving, how does one "break his spirit"?
Please help me!!
Thank you.
-Janet
Dear Janet: No child ever learned good eating habits by "having his spirit broken" or by being pressured to eat by a loving, worried mother. At two years of age, the growth rate has dropped, and with it, the appetite. With a decreased appetite, it is not unusual for previously good eaters to become picky. They're just not hungry enough to eat what they don't want. In countries where food isn't readily available, children aren't picky eaters, but your child knows food is available, and it wouldn't be reasonable to starve him for a while to change his attitude.
The first thing you should recognize is that if your son is eating enough to maintain growth in the 90th percentile, he is eating enough calories. If he gets at least 8% of his calories from good quality protein, which he should easily accomplish by drinking two bottles of milk each day, he won't become malnourished. If his diet isn't balanced, a vitamin and mineral supplement will serve as an insurance policy against deficiencies which could result, but it may not even be necessary since most breakfast cereals, including Cheerios, are vitamin fortified.
If your pediatrician and his aunt, the pediatrician, have reassured you that your son is healthy, you should take their word for it and relax. If you take the pressure off yourself it will take the pressure of your son, and this may make mealtime more pleasant, ultimately resulting in better food intake. But you mustn't be looking for miracles. If good food is made available with only a few choices per meal and your child isn't allowed to substitute junk and sweets for meals, and if each meal has a definite beginning and end rather than a "sit until you eat", your son will gradually add more foods to his repertoire.
Please read my article, Nutrition Without Tears.
Sincerely,
Dr. Warren
Thankyou very much.
-Andrew
Dear Andrew: It is not unusual for a person to hear the sound of blood "whooshing" through the temporal artery when he leans on his ear; however, generally blood flow through the arteries is relatively silent. Since you hear the sound in only one ear and you hear it all the time, it suggests that there is something going on in that ear that is amplifying the sound or something going on in that artery which is making the sound noisier than normal. I'd suggest you have it checked out.
Sincerely,
Dr. Warren
-DP
Dear DP: If you have an infection related to a tooth, you should consult a dentist for appropriate treatment. While antibiotic treatment may be appropriate, the definitive treatment would be repair, drainage, root canal, or removal of the tooth.
If your doctor is treating an infection elsewhere in your body, he should tell you what he is treating and explain in detail how the diagnosis was made and what your treatment options are. If your doctor eliminates the mystery, then you can play an intelligent role in setting up a treatment plan.
Very few infections require thirty days of antibiotics, but since I don't know what your doctor is treating you for, I can't comment on his choice of treatment.
Sincerely,
Dr. Warren
Help!
Yours Sincerely,
-Concerned Cousin
Dear Concerned Cousin: If your 6 year old cousin is on two medications for ADD, she must have a significant problem which was not controlled adequately by one medication, therefore, it is not routine; however, these medications are appropriate for the treatment of ADD. Many medications have more than one use.
It turns out that medications which control blood pressure work not only on the nerve endings in blood vessels but also affect neurotransmitters in the brain. One of the first effective antipsychotic medications, Reserpine, was found to help psychosis when it was being used to treat hypertension. Clonidine is useful in the management of some behavioral aspects of ADD. When it is used to treat ADD the dose is started low and the patient's blood pressure is monitored while his system adjusts to being on the medication.
Stimulants like Ritalin and Dexedrine (dextroamphetamine) are used to treat ADD because they increase concentration and attention span and can help to decrease hyperactivity. One of the undesirable side effects of stimulants is that they are appetite suppressants, which is why they are used as diet pills. Children who are taking stimulants must have their weight, nutrition, and growth monitored.
Sincerely,
Dr. Warren
Sincerely,
-Mrs. AT
Dear Mrs. AT: Since you are operating a childcare facility, if you have any concerns about whether a child's condition poses a risk to other children, you are entitled to request that the child be evaluated by a physician and to refuse the child admission without medical certification that he is not infectious.
The child in question certainly could have developed a secondary infection from scratching himself, but the presence of open sores does not mean that they are infected. It might benefit the child to have his sores covered, but unless he has a skin infection, his open sores pose no risk to the other children.
The rash of scabies tends to be distributed on the body between the fingers, under the arms, around the waist, and around the genitals. The fine rash on another child's back and abdomen does not sound related to the first child's rash. As regards your itching, unless you develop a scabies type rash, it also could have nothing to do with the rashy child, or it may be a result of anxiety about the child's rash.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
