20 December 1999

1. No Toys for William This Christmas
2. Heat or Ice
3. Hemoglobin Barts
4. Normal X-Ray, Severe Leg Pain
5. Lungs
6. Hyper Baby
7. Sleepy Newborn
8. Excess Infant Weight Gain
9. Disclaimer

• Read Questions & Answers in Another Column

I will appreciate and look forward to your reply. Thank you.

-Grandma

Dear Grandma: I can understand your distress, but you must remember that you are not privy to all the details of why William's mother feels he needs to be disciplined this way. I would hope that his mother will not ruin Christmas since it is such a magic time of year for children. But keep in mind that the threat of no gifts for children who misbehave has always been part of the Christmas mystique. Children have been told through the ages that Santa is watching to see if they are "naughty or nice" and that bad children get a lump of coal in their stockings instead of a gift. The risk is to not state the threat so strongly that a parent has no choice but to follow through or lose credibility. Unless a child is truly able to understand and misbehaves badly in spite of his understanding, it is best for a child not to pay such a high price as missing a rare and special event. Punishments can always be meted out in another way on another day as long as the child is aware that his reprieve is only the result of the special occasion and punishments will not be routinely postponed.

Mom may still make the best of this situation by telling William what he must do to make amends, and then in the spirit of charity and teaching her child how to behave, she should accept his efforts even if they are less than perfect. And while we're talking about charity, if Mom thinks William has too much and doesn't appreciate what he has, why not help him participate in the joy of giving by visiting a shelter or poor community and giving some gifts to those who have less.

As to the effect this will have on William, a lot more depends on how William's mother treats him all year than what happens on Christmas. Children are resilient, and William will get over this before you do. The loss of one Christmas will not damage him and there will be other Christmases. On the other hand, if William's mother is emotionally abusive to him, he will carry scars for the rest of his life that even wonderful Christmases will never erase. Children are our future. They are truly God's most precious gift. They need discipline in the form of a strong but gentle guiding hand that is nurturing and loving.

Happy Holidays!

Sincerely,
Dr. Warren

-Leo

Dear Leo: Use ice on an acute injury or for treating chronic injury or inflammation to decrease blood flow to the area and decrease swelling. Use heat to increase blood flow to an area and speed healing when an injury is no longer inflamed or when there is infection.

Sincerely,
Dr. Warren

-C

Dear C: Hemoglobin Barts is a hemoglobin consisting of all gamma chains. Normal A hemoglobin is made of alpha and beta chains. Gamma chain production generally ceases between 3 and 6 months so that the Hemoglobin Barts may disappear. Hemoglobin Barts usually occurs when there is decreased alpha or beta chain production which is what Thalassemia is. At 15 months of age, if your son has no findings suggestive of Thalassemia, he most likely has the trait rather than the disease, in which case your doctor is correct in stating that the main concern would be if he marries someone who also carries a trait for a genetic anemia. Thalassemia trait is inherited, although it could occur as a new mutation. You and your husband could be tested to see if either of you carries the trait, but what is more important is for your son to be tested so that you know exactly what he has and your mind can be put at ease. Since the trait doesn't cause any significant symptoms except a mild anemia, it is not surprising that you and your husband are not aware of any family history of the disease. You may have to delve quite deep to find relatives who have knowledge of it.

Sincerely,
Dr. Warren

Thank you.

-L

Dear L: If your son is complaining of severe pain he should be evaluated by an orthopedist. X-rays do not pick up all injuries. A soft tissue injury or an inflammation of a joint after injury may not show up on x-ray. A hairline fracture or a fracture through a growth plate may also be difficult to find on the initial x-ray.

Sincerely,
Dr. Warren

Questions:
1. What is vital capacity and why is it important?
2. What is reserve air capacity and why is it important?
3. What are good things for your lungs?
4. What are bad things for your lungs?
5. What can or should an elementry age child do to improve their vital capacity?
6. What can or should a middle school and high school age child do to improve their vital capacity?
7. What can or should an adult do to improve their vital capacity?
8. What can or should an eldery person do to improve their vital capacity?
9. How can we all keep our lungs healthy?
10. What are some of the most common diseases that affect our lung capacity?
    (if possible could you name some for each of the 4 age groups I mentioned above?)

Sincerely,
Brenna :)

Dear Brenna:

• 1. Vital Capacity is the greatest volume of air that can be expressed from the lungs (breathed out) after a maximum inspiration (breath in). In other words, it's the largest amount of air that a person can breathe in and out. It is important for a person to be able to breathe all the way in and out for proper lung function. If a person cannot fill his lungs fully or empty his lungs completely his vital capacity will be decreased. People who have diseased lungs will have a decreased vital capacity because they have less normal lung tissue to fill with air. A deformity of the chest, muscle weakness, severe curvature of the spine, or anything that interferes with movement of the diaphragm will decrease the amount of air a person can breathe in and decrease his vital capacity. People with asthma and emphysema have difficulty getting all the air out of their lungs, so their vital capacity is decreased.
• 2. I am not familiar with the term "reserve air capacity." The reserve volumes are the amount of air a person can still breathe in or out after a normal breath. These are important because they determine just how much extra breathing you can do above normal when you need to such as for running.
• 3. Good things for your lungs are nice fresh air and plenty of exercise.
• 4. Smoke and air pollution are very bad for your lungs.
• 5,6,7,&8. Vital Capacity is mostly based on body size. It is important for your lungs and body to stay healthy so that your Vital Capacity doesn't decrease. Vital Capacity may increase slightly for any age with regular exercise that stimulates heavy breathing and keeps your chest muscles and diaphragm strong. More important, regular exercise improves the way the heart and lungs work together to bring oxygen to your body.
• 9. The most important thing anyone can do to keep his lungs healthy is NEVER SMOKE. Regular exercise can keep your lungs strong. Good hygiene (careful hand washing) can help prevent infections which might damage the lungs. Good nutrition is important to keep the body healthy (including the lungs) and help any damage to heal. Avoid exposure to fumes, asbestos fibers, fiberglass fibers, coal dust, soot, talc, etc.

  If you have a lung disease, be sure to see your doctor regularly and follow your treatment regimen.

• 10. Asthma is the most common disease affecting lung capacity. It occurs at all ages but occurs at the greatest frequency before the teen years and may persist for life. Emphysema occurs mostly in middle and old age and is often caused by cigarette smoke. Lung cancer also occurs mostly in middle and old age and is also often caused by smoking. Infections like pneumonia and tuberculosis can occur at any age. With proper treatment, most infections can be cured so their effect on lung capacity is usually temporary. Cystic fibrosis is an inherited disease which can severely affect the lungs and generally starts causing symptoms in infancy.

Sincerely,
Dr. Warren

Second example, he has begun to go crazy in the tub. He has always loved bath time and we encourage fun in the tub. He now splashes water everywhere, jumps around, swims from one end to another, and gets the entire bathroom soaking wet. We have had to limit the amount of water in the tub. And overall he has become a dare devil in every situation. Is this normal for this age or am I being overly concerned? He will not respond to time out. He immediately gets up from where I put him and if I put him in his room he screams bloody murder and trys to get out. It settles nothing.

Please advise.

-Allison

Dear Allison: Children change so much during the first few years of life that it's sometimes difficult to be sure what is a natural development and what is a response to stress or external stimulation. Personalities vary considerably from child to child. It is safe to say that not all 18 month olds exhibit aggressive or wild behavior, but many do. Sometimes learning what's acceptable behavior requires being disciplined for unacceptable behavior. As a result, some children who were never a problem to control sometimes become unexpectedly difficult since their previous good nature was a case of good fortune rather than learned behavior.

If your child's behavior represents a sudden departure from his previous behavior, a discussion with his daycare provider is in order. Perhaps he has learned to be aggressive in response to or from another child. If nothing has changed in daycare, a look at the home situation is in order to see if any stresses may be affecting his behavior. Young children may often have no clue what's going on in the adult world around them, but they can certainly sense when something is wrong.

Time out is an effective means of disciplining even young children, but it must be enforced consistently and be kept long enough to make an impression, yet short enough to match the understanding and attention span of the child. It also shouldn't be the first resort. Redirecting a child's behavior through distraction, gentle guidance, and substitution of alternative behaviors should be the first approach. For more information read my article, Managing the Difficult Child: Toddlers.

Sincerely,
Dr. Warren

-DA

Dear DA: Normal newborns sleep as little as 12 hours a day and as much as 22 hours each day. If your son is nursing well and gaining well then there is no need to worry.

Sincerely,
Dr. Warren

Thank you.

-SR

Dear SR: Four pounds is a huge amount of weight gain in 1 month for a newborn, but whether or not it is excessive depends on how many inches he grew. His current weight is in the 97th percentile. If his height is in the same percentile, you're simply dealing with a child who is growing rapidly. I've seen skinny babies wolf down 8 ounce feedings, and I've seen chubby little babies eating only 4 ounces at a feeding, so it's difficult to give exact guidelines. Parents need to avoid feeding infants for every cry because it teaches children to use food to deal with any distress, but when an infant is hungry, he should be fed. The idea of a mother sitting on the edge of her bed watching a clock while her baby screams to be fed is absurd. After most infants settle in, they will find a reasonable amount to consume for normal growth. Some infants tend to gain excessively, probably based on a genetic predisposition. Many of these babies slim down as they get older, but if you believe that the number of fat cells a person has will affect his weight later in life, it seems wise to avoid getting infants too fat. If a baby continues to gain weight in excess of height, which can best be judged by looking at his growth chart for height and weight, then the simplest thing to do is to add some water to each bottle.

I do not believe you are doing anything wrong. If your baby's weight gain is truly excessive, your doctor can help you work out a feeding schedule and an appropriate formula dilution without accusing you of being a bad parent.

Sincerely,
Dr. Warren

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