11 October 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
-LW
Dear LW: The spleen is a part of the blood and immune system in the body. It is next to the stomach and is completely protected by the ribs. The spleen enlarges in response to certain virus infections and blood diseases. Fever, swollen glands, and enlargement of the spleen are very common findings in mononucleosis. When the spleen is significantly enlarged, especially if it is large enough to extend beyond the protection of the rib cage, there is a risk of injury to the spleen from rough play. Since the spleen is a blood filled organ, such an injury could cause serious internal bleeding. Normal activity without roughhousing will not cause any injury to an enlarged spleen. There will not be any permanent damage as long as the spleen doesn't get injured. If your son complains of any pain in the left side just below the ribs, it could be from his spleen and should be checked by the doctor.
Sincerely,
Dr. Warren
-Melissa
Dear Melissa: It is difficult for me to be sure whether you need to be concerned about your daughter's symptoms. Early morning vomiting can be a symptoms of increased intercranial pressure, so it could be related to the history of prior head injuries. If these symptoms continue and your daughter has headaches, she must be reevaluated. On the other hand, the vomiting associated with head injuries is not accompanied by diarrhea. This suggests that your daughter's problem is primarily intestinal rather than neurological. It is unusual for a child to have these symptoms only early in the morning and then be fine all day. As long as she is fine all day and tolerating fluids, you can give it a little time to see what happens. An intestinal virus could last a few days. If the symptoms last more than a week or become more severe then your daughter must see a doctor.
Sincerely,
Dr. Warren
- BGJ
Dear BGJ: Many babies suffer hematomas on the head and misshapen heads from delivery. A newborn's head was made to be flexible in order to squeeze through a birth canal. Since the brain is soft, it does not suffer any injury from the gentle compression associated with most deliveries. The head shape generally goes back to normal, but since the pediatrician wrote "cranial deformity" on the chart, you must ask him whether there is a deformity which goes beyond the molding that occurs during delivery.
Unless the doctors feel that there is a condition existing now which could require intervention, such as bleeding inside the head, there are no tests to look at the condition of the baby's brain. If the baby feeds poorly, is limp, has seizures, is irritable with a high pitched cry, then neurological damage may be suspected. Otherwise, you must see how the baby develops and seek appropriate intervention if there are any developmental lags.
Sincerely,
Dr. Warren
-Elaine
Dear Elaine: Without knowing the child's medical diagnosis, it is not possible for me to tell you whether or not she has an increased risk of infection. If her immune system is normal, her small size does not put her at increased risk for infectious disease. It is possible, if she has an endocrine (glandular) disorder affecting her size, it may play a role in her condition. Children with adrenal insufficiency may run fevers and have swollen glands if they are not on an appropriate dose of replacement steroids. In addition, when they become ill, their dose must be increased to cover for stress.
The frequency of fevers you describe associated with swollen glands certainly requires further evaluation even if it occurred in a child with no other medical conditions.
Sincerely,
Dr. Warren
| Age | T4 | TSH |
| 1 | 95 | 7.3 |
| 7 | 100 | 7.3 |
| 30 | 46 | 5 |
-Worried Father
Dear Worried Father: If the unit of measurement is the same as in my references, your baby's T4 is significantly elevated, making the baby hyperthyroid. The purpose of the scan is to look for thyroid nodules and ectopic thyroid tissue (thyroid tissue located outside the thyroid gland). The scan involves an intravenous injection of radioactive material which is concentrated in the thyroid gland followed by scanning with a machine which reads the location and concentration of the radioactivity. Hyperthyroidism is treatable with medication or surgery depending on the cause. Lack of treatment could interfere with proper growth and development and make your baby very irritable and nervous. If your doctor is not a specialist who deals with pediatric glandular conditions (a pediatric endocrinologist) you might want to consult such a specialist before proceeding with further evaluation or treatment.
Sincerely,
Dr. Warren
| Age | TSH | T4 |
| 1 | 95 | 6.8 |
| 7 | 100 | 7.3 |
| 30 | 46 | 5 |
-Worried Father
Dear Worried Father: A high TSH is one of the best tests to diagnose primary hypothyroidism. The T4 is not low, but it is being maintained in the low normal range by a pituitary gland which is pouring out huge amounts of TSH to stimulate the thyroid to produce T4. A scan would serve to look for the size and location of the thyroid, but since the baby's T4 is so far normal, there is no question that there is a thyroid. I'm not sure how essential the scan is and suggest my original advice, which is to consult a pediatric endocrinologist.
Hypothyroidism left untreated can result in poor growth and mental retardation. Fortunately, treatment is not difficult. Thyroxine can be given by mouth to replace the missing thyroid hormone. This is not a "do it yourself" treatment, since the T4 levels must be monitored to adjust the dose, but under the guidance of a pediatric endocrinologist, parents treat the condition at home with results that are just as good as children who have normal thyroid function. It is a condition which requires lifelong treatment.
Sincerely,
Dr. Warren
-MG
Dear MG: They don't teach you about the timing of eye color change in medical school, but here's my personal experience. My son's eyes stayed the typical slate gray color of newborn's eyes until he was 14 months old and then turned green. They stayed green until he was 3 years old and then turned hazel. Generally, the darker the eyes will be the earlier they change. Often children with dark brown eyes have brown eyes by 3 months of age. Blue and gray eyes are actually lighter than the color of newborns' eyes, so if your baby's eyes have gotten lighter, they will very likely stay blue.
Sincerely,
Dr. Warren
Thank you very much.
-RT
Dear RT: High cholesterol may be related to genetic factors. It may also be related to diet. A child does not need to be overweight or even have an unhealthy diet in order to be consuming too much saturated fat and cholesterol. If you review your child's diet with your doctor or a nutritionist, you may be surprised to find significant amounts of fat in foods like cheese, cold cuts, ice cream, mayonnaise, etc.
Before we charge ahead with concern about your son's cholesterol, the first question is, "was this a fasting level?" If your son had just eaten a ham and cheese sandwich, these results are meaningless. No action should be taken until your son has a complete lipid profile done on a fasting blood.
Sincerely,
Dr. Warren
-RM
Dear RM: There are no medications which cure colds or eliminate mucus, but there are many which provide symptomatic relief of cold symptoms. If your child is coughing to the point of vomiting, a cough suppressant like dextromethorphan along with a nasal decongestant may help. Examples of these medications include Robitussin CF, Triaminic DM, and Robitussin Pediatric Drops.
If your child is vomiting once each day but retains most of her feedings and is acting well, her symptoms may just improve on their own as she gets over the cold causing them. We do see a lot of bronchitis this time of year, so if your child seems sick or the cough is severe, she should see her doctor.
I do not believe teething is causing her problem.
Sincerely,
Dr. Warren
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