Questions from visitors to our Ask-an-Expert site might provide the answers you're looking for!
| Q | I have a 10-month-old who often gets colds from daycare, etc. When he gets these colds he tends to cough at night. I have been giving him Tylenol Cold and Cough, but recently in the news they are saying that you should not give this to children under the age of 2. So, is this true, and will it hurt since he has had it in the past. What do they suggest for the cough so that he can sleep at night. Often he coughs so much he ends up vomiting. | |
| A | One of the main reasons that we no longer recommend cough and cold medicine is that studies show that it does no good. I don't think you need to worry that you have done any harm to your child by giving it in the past. There have been children who have been overdosed on cough and cold medicine - another reason not to give it. Sometimes children who have excessive coughing with colds, actually have a mild form of asthma. You might ask your child's doctor, the next time you are in the office, if she/he thinks your child might have some mild asthma. | |
| Answered by Doug Gamet MD, Pediatrics, Eugene, PHMG/PED-Willamette (10/2/2007) | ||
| Q | My daughter just turned 4, and she has underarm body odor like an adult. It is only noticeable after she has been very active. I'm concerned about early puberty. How valid is this concern? | |
| A | This may be a sign of androgen(a hormone) production and should be evaluated by your pediatrician. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (4/19/2007) | ||
| Q | My son was given a prescription for fluoride (EtheDent Chew, 1 mg) by his dentist. I want to make sure this is the appropriate dosage for him at 4 years of age (40 lbs) with the knowledge of any naturally occurring fluoride in the water (I don't know if we have any here in Eugene). What is a safe dosage for my 2 year old (25 lbs)? | |
| A | The fluoride dose is 0.25 mg for ages 6 months to 3 years, 0.5 mg for ages 3 years to 6 years and 1.0 mg for age 6 years to 12 or so years. There is no fluoride added to the Eugene city water. | |
| Answered by Doug Gamet MD, Pediatrics, Eugene, PHMG/PED-Willamette (4/12/2007) | ||
| Q | What is Rotavirus? What are the dangers for a one-year-old? | |
| A | Rotavirus is a common winter viral illness causing fever, vomiting, and diarrhea. The illness is self-resolving and usually occurs in children under five. The treatment is prevention of dehydration during the illness, which is the only danger. Children may become infected twice, then develop natural immunity. Vaccination beginning in the first six months of life may prevent severe illness. | |
| Answered at 3/12/2007 | ||
| Q | Do doctors test infants for the presence of drugs after the birth and discharge from the hospital? | |
| A | Newborns are tested for the presence of drugs of abuse after birth on an "as indicated" basis. If there is a history of drug abuse by the mother, then generally the infant will be tested. If there are issues with the infant's social situation that might put the mother at risk for drug abuse, then the infant will be tested. If the infant shows symptoms of possible drug withdrawal in the first few hours of life, then the infant will be tested. The bottom line is that we do not test every infant for drugs of abuse, but we try to test every infant who may be at risk for drug exposure during the pregnancy. | |
| Answered by Doug Gamet MD, Pediatrics, Eugene, PHMG/PED-Willamette (12/28/2006) | ||
| Q | Can a 1-month-old be given Pediacare for nasal decongestion? | |
| A | At 1 month of age, I would suggest just using saline nose drops and a bulb syringe for clearing nasal secretions. Pediacare could be used, but sometimes the side effects like fussiness or wakefulness are worse than just dealing with the cold. If the baby runs a fever, you should see his or her physician. | |
| Answered by Doug Gamet MD, Pediatrics, Eugene, PHMG/PED-Willamette (2/7/2006) | ||
| Q | What is the right age to wean a child from a pacifier or bottle? | |
| A | It is generally recommended that children be weaned from the bottle at around 12 to 15 months of age. This is for several reasons. First, milk or juice in the bottle will help to cause cavities in the teeth. Second, children who have a bottle tend to get more of their nutrition from milk and juice and less from solid foods. This tends to lead to poorer nutrition. Pacifiers have no real drawbacks to prolonged use. Some children have very strong sucking urges and seem to be more content with a pacifier. | |
| Answered by Doug Gamet MD, Pediatrics, Eugene, PHMG/PED-Willamette (12/13/2005) | ||
| Q | My son has been running a high fever for 2 days. It has been between 102 and 104.8 degrees today, though it has been mostly 104. At what point should we become worried? He saw his physician today and was told that it was a virus. | |
| A | A normal course for viral infections in children often includes fever for 3-5 days. The height of the temperature itself (i.e. what number) is not a point of concern. A higher temperature may cause him more discomfort, but not danger. Fever may affect children with other special medical problems differently. He should be re-examined should his degree of illness progress to difficulties breathing, taking liquids, skin rash, or a very low level of alertness that persists. Childrens' alertness is normally lower at the time their fever is high, but improves when the fever is lower or absent. A temperature of more than 100.4 degree for more than 5 days should be discussed with his physician by telephone or in the clinic. | |
| Answered at 11/19/2005 | ||
| Q | What are the viruses for which mothers are tested if they wish to donate their breast milk? | |
| A | Donors are tested for HIV, Hepatitis B and C, Syphilis, and HTLV (Human T-cell Lymphotrophic Virus). If a donor has spent 2 weeks or more in Europe they are disqualified as there is no test for Mad Cow Disease. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (11/14/2005) | ||
| Q | My 22-month-old daughter has suddenly started having wild temper tantrums. There seems to have been a sudden switch from the way she used to be when upset to the tantrums she is having now. She now gets extremely upset at the slightest thing. For example, this morning she tried to pet the cat and it ran away from her. She threw herself on the ground and was hysterical--screaming, crying, practically hyperventilating and wouldn't let us come near her to comfort her. It took a good 20 minutes for her to calm down. She never used to get so upset. Previously she would throw the occasional tantrum, but it wasn't nearly as wild. She has also recently become afraid of imaginary tigers in her room at naptime(and occasionally at bedtime) and screams as though terrified out of her mind and tells us "tigers scare me" and "big tigers hiding in room". There have been days when it has taken almost 2 hours to get her down for a nap for this reason. Is this normal behavior or is something wrong? I am really worried that her emotions are completely out of her control and that her imagination is running amok and I am not sure what to do. | |
| A | It sounds to me like it is normal "terible twos" setting in. The best advice is to not overact to her fits and, essentially ignore them, perhaps even remove her from the family environment to her room or crib. Once she realizes there is no secondary gain the fits should settle down. These meltdowns are always worse when children are hungry or tired. I recommend a book by John Rosemond called, "Return to Parent Power" for more information in this regard. As far as the imagination, that also is a normal behvior. I would not ignore the fears but not be overly concerned. Consider having a "protector stuffed animal" or "tiger spray" before naps, but do not let her play off this and let her expand the pre-sleep time. Be careful what she sees on TV as this can really increase the imagination fears. Good luck! | |
| Answered by Doug Gamet MD, Pediatrics, Eugene, PHMG/PED-Willamette (9/8/2005) | ||
| Q | What are the newborn screening tests? Please give me a list of what my child will be tested for. | |
| A | Oregon has always been a leader in the country in Newborn Metabolic Screening, and the list of screened disorders is always growing. The best resource is the Oregon Department of Human Resources web site for the current list of tests performed for Newborn Screening. You can also view the pamphlet they have prepared for parents to explain the program at their web site. | |
| Answered by Doug Gamet MD, Pediatrics, Eugene, PHMG/PED-Willamette (1/16/2005) | ||
| Q | I am getting ready to have a baby and my soon-to-be pediatrician told me that sometimes Sacred Heart hospital will test babies for drugs. I am not on drugs and don't want any tests done that aren't necessary. What is the hospital's policy on this? Also, can I find out what tests will be done to the baby after it's born and what my rights are? ..will I be notified of any tests that may take place? | |
| A | Babies are screened for drug exposure at both SH and MW for history of maternal drug use, inadequate prenatal care or late prenatal care, or no prenatal care. This test is not done routinely and if it is done on babies the parents are notified as to the reasons. It is routine for babies to get prophylactic eye antibioics, vitamin k injection, newborn testing- ie PKU, hearing screening and a transcutaneous bilirubin (checks for jaundice). You should be notifed of any testing and none should be done if you request them not to be--however the pediatric community feels all these are important for the health of your baby. | |
| Answered by Paul Bouressa, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (5/11/2004) | ||
| Q | My daughter is 4 weeks old as of yesterday. We have weaned her to a bottle and she is exclusively on formula. Throughout the day and night, she eats between 3.5 and 4 ounces every three hours. Is this a lot? I've heard of some parents giving younger children cereal earlier than normal if they are big eaters. Should I begin giving her something to fill her stomach a little better? | |
| A | Your daughter has a healthy appetite, but her intake is in the normal range. I would not recommend starting cereal yet. A 4 week old will not be able to adequately digest the cereal, and she needs the more calorie-dense formula to satisfy her. Contrary to some reports you may have heard, starting cereal is not the magic cure to night time feedings. It may even cause her tummy ache or constipation and she may even sleep less! Her formula is adequate for all her nutrition needs at this age. | |
| Answered by Tamara Barstow, MD, Pediatrics, Eugene, PHMG/PED-Barger (4/1/2004) | ||
| Q | My 8 months baby passed some hard stool and got her anal passage bloody. What can I do? | |
| A | Your baby has had a small tear in her anus, either on the outside or just on the inside, from passing the hard stool. This is quite common in babies and young children. This tear will heal on its own if the stools are soft from now on. If you can see the tear, you can put some ointment, like Aquaphor, on it to soften up the skin there. If you can't see it, you don't need to use anything. If your baby continues to have hard stools, you should talk to your doctor about ways to help soften the stools. This could delay the healing and re-tear the area. | |
| Answered by Tamara Barstow, MD, Pediatrics, Eugene, PHMG/PED-Barger (3/3/2004) | ||
| Q | I need information on Vacterl syndrome. | |
| A | Vacterl syndrome is an acronym for a nonrandom collection of abnormalities which are often seen together more commonly than pure chance alone would predict. It's also called: vater association; v-vertebral defects; a-imperforate anus; c-cardiac anomilies; t,e-for tacheoesophogeal fistula; r-renal or kidney abnormalitis; l-limb anomilies You can find out more at the web site Vater Connection. | |
| Answered by Paul Bouressa, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (9/5/2003) | ||
| Q | What should I do for dehydration? | |
| A | Dehydration usually occurs with a gastrointestinal illness (vomiting and/or diarrhea), which generally resolves spontaneously. Other less common causes include diabetes, and kidney or hormone problems. The treatment of dehydration depends on the severity, and the underlying cause. The normal frequency of urination is about every 4 hours, and when it stretches to every 8 hours, thirst increases. At 12 plus hours between voiding, significant dehydration exists and will be associated with increasing lethargy. The usual treatment for dehydration is done with oral rehydration solutions. Water is appropriate for mild dehydration. Electrolyte solutions such as Pedialyte, Lytren and others are recommended for more significant dehydration. Small amounts given frequently is the way to help hydrate someone with vomiting. Rarely will this not work, and in those cases intravenous fluids are called for. Lastly, please note that it is rarely necessary or appropriate to use suppositories or other medicines such as Emetrol, Kaopectate, etc. Please write back if you have additional questions about this. | |
| Answered by David Miller, M.D., , , (10/28/2002) | ||
| Q | My son is four years old and he is very active. I have been asked a few times in the past year if he has been tested for ADD or ADHD. I ignored it for a while because he never really acted like the typical ADD or ADHD kids do. Now I am noticing a lot of tension and uncooperativeness in him along with other symptoms. What should I be looking for and how can I tell the Dr. what I am seeing without sounding like I don't know anything? Should I be worried about something like this and are there any other measures I could take without having to put him on medication? | |
| A | Express your concerns to your child's doctor the same way you expressed them in your note to me, and he/she will be able to help you. You are already two jumps amd a conclusion ahead when you talk about medicines. Most behavioral problems are not ADHD and most do not require medications. On the other hand, I would not delay. I recommend you set up a visit to your child's physician now. Most behavior problems do not get better on their own, but many do respond to simple interventions. For some background information on child development you might look at Healthwise, on the PeaceHealth website, at Growth and Development, 2 to 5 Years. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (10/2/2002) | ||
| Q | Can you please tell me about "Fifth Disease"? | |
| A | Fifth Disease is usually a mild illness caused by Parvovirus B19. Another name for the the disease is Erythema Infectiosum. The most distinctive feature of the illness is a rash which starts as bright red cheeks, and then spreads down the body, arms and legs in a lace-like pattern. There may be a mild fever, headache, or achiness before the rash appears. Some people, especially adults, also develop joint pain or swelling. The rash can recur for months after the initial illness. For most people, the illness is very mild. For a few people, the illness can be much more serious. The infection can cause severe anemia in people who have disorders of their red blood cells, such as sickle cell anemia or thalassemia. If a pregnant mother becomes infected, the fetus can also develop severe anemia. | |
| Answered by Lauren Herbert, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (6/12/2002) | ||
| Q | My grandchild has been diagnosed with "roto virus". I have never heard of this before. What is it? | |
| A | This is the name of a virus that causes a "stomach flu" type of illness. It is one of the most common causes of chilhood vomiting and diarrhea from an infection. It tends to "go around" in the late winter. It seems to take 1-2 weeks to completely resolve and sometimes causes dehydration. It is EXTREMELY contagious--watch out! | |
| Answered at 5/14/2002 | ||
| Q | What is a pilonoidal sinus? The pediatrician who checked my healthy new- born grandson last week found this, and suggested an MRI. We would like more information on what it is, and what the effect of this sinus might be in the future. | |
| A | I believe your grandson's doctor was referring to a dermal sinus. It looks like a very deep dimple or pit behind the anus that you can't see the bottom of. It may be attached to the baby's tailbone. There may be an open channel there that can get infected and may be connected to the baby's spinal canal. If it is connected, it could cause what we call a "tethered cord", meaning that it causes traction, or pulling on the spinal cord as the baby grows. Or it could allow infection to spread to the spinal canal, even cause meningitis. The pediatrician is recommending an MRI to see how deep the pit is, or if it is a true sinus, or channel to the spinal canal. If it is attached to the spinal canal, it would require surgery to avoid the potential complications I mentioned. If it isn't very deep, the doctor would likely just watch it. A pilonidal sinus is actually another type of pit in the same area that is acquired, or develops over time. It can get obstructed, causing an abscess, or cyst. Then, if it gets infected, it is really painful and requires drainage or excision (removal). If not infected, it requires no treatment. | |
| Answered by Tamara Barstow, MD, Pediatrics, Eugene, PHMG/PED-Barger (5/2/2002) | ||
| Q | My 6 and a half month old son has not had a bowel movement for 7 days, though he's eating, passing gas, and urinating regularly. He is breastfeeding only. I have not introduced any solids at this point. He seems in very good spirits (happy, laughing, vocalizing), is very active (cut first tooth a week ago, sitting up on his own, pulling to stand in crib, scooting, rolling, semi-crawling, happily into everything), has no fever, no signs of dehydration or illness, but this is the longest he's gone without a BM. Should I be concerned? Are there any warning signs I need to watch for? | |
| A | While most exclusively breast fed children at six months can be expected to have a bowel movement at least every 3 to 5 days, a child may occasionally go longer. As long as he is acting well with good appetite and no grunting, straining, or fussiness, there is no reason to worry. At about 7 to 10 days I get a bit concerned just because of the unusualness of the time involved and usually recommend an infant glycerine suppository. In my experience the children have invariably pooped and gone on to be fine. The record in my practice has been 15 days. Seven days without stool in a newborn or in an infant on a broad diet has an entirely different significance. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (1/29/2002) | ||
| Q | My son has had bowel movements in his pants since he was 3. He never goes to the bathroom to do this; it is always in his pants. But he does not do this at school. His doctor seems to think that it is a control issue. | |
| A | The problem of soiling is called encopresis. It is really quite common and is understandably not often talked about. This can usually be dealt with and resolved, but absolutely requires multiple exams/counseling with the pediatrician. Sometimes xrays are done,and various bowel cleanout programs are prescribed. You can read about encopresis at Stool Soiling in Children on Family Doctor. | |
| Answered by David Miller, M.D., , , (1/29/2002) | ||
| Q | My 2-year old daughter has mild asthma treated with one puff Flovent daily. She was recently accepted into a desirable preschool but I learned that the teachers (husband/wife in their home)have 2 cats in the house which sometimes visit the kids. I've heard that kids with asthma should not be around cats. Is this true? Will 2-3 times per week for 3-4 hours each at this location influence her asthma? What are your thoughts? | |
| A | There is no absolute answer I can give you, but, my strong recommendation would be to keep your young daughter away from cats as much as possible. Why put her in (potential) harm's way? Cat exposure is one of the major causes for allergic inflammation leading to the development of chronic asthma. Few 2 year olds demonstrate clinical allergy, but many are at high risk. If there is ANY history of allergy in mommy or daddy (not just to cats) then the exposure risk, in my estimation, is really too high. Several hours a day for several days a week is a lot; studies show that allergic peoples' lungs can show increased reactivity for up to several weeks after a single point of exposure, so ongoing exposures are even worse. More importantly, try to keep her in a daycare setting where there are only a few (less than 3-4) other kiddos. That will decrease her chances of always catching the "virus of the week", which are the main immediate triggers for asthma episodes. | |
| Answered by David Elkayam, MD, Allergy & Immunology, Bellingham, Bellingham Asthma Allergy & Immunology Clinic (12/11/2001) | ||
| Q | I have an 8 month old child who is not interested in eating solids! I have tried several things: cereal, veggies and fruits, nothing seems to strike her fancy. She is still breastfeeding, occasional soy formula supplement and is gaining weight (although, slowly). Any suggestions or should I be concerned? | |
| A | There is no reason for worry as long as your child is growing and developing normally. Although most Pediatricians recommend starting solid foods at 6 months, there is no evidence that children require any foods other than breast milk before 9 months of age. In fact, prior to the 1920s children in this country routinely started solids on their first birthday. When the time comes that you want to insist your child start solids you merely have to cut back on the breast feeding and hunger will solve your problem. However in order to limit breast feeding you will have to go from demand feeding to some sort of nursing schedule. Discuss this with your pediatrician. He or she can assure you that your child is healthy and can further advise you regarding this eating problem | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (10/4/2001) | ||
| Q | My daughter was stung by a yellow jacket on a finger. Three of her fingers and part of her hand were swollen by the next day. Does this indicate that she is at increased risk for developing an allergy to bee stings in the future? | |
| A | David Elkayam, MD, Pediatrics, Allergy and Immunology responds: The question relates to management of what is known as a "large local reaction" (note the highly technical language here) This is to differentiate a large local reaction from a systemic or ananphylactic reaction. Whereas a systemic reaction is potentially life-threatening and requires immediate and intensive therapy, a large local reaction: *develops much more slowly (over 1-3 days) *does not cause breathing difficulties or rash at a site distant form the sting *does not pose any increased risk for a systemic reaction in the future *does not require a trip to the doctor (or the ER) *does not require any specific therapy. I like the home remedies (ice, baking soda) you are using. Topical or oral steroids are occasionally prescribed to speed resolution of the swelling and inflammation. Antibiotic should only be considered if signs of infection are identified (i.e., enlarging area of redness and tenderness, pus exiting from the envenomation puncture site, redness streaking from the area towards the central body. Oral or topical antihistamine (e.g., Benadryl) is ineffective. | |
| Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (8/29/2001) | ||
| Q | There is a family history of asthma. My 19 month old daughter has had a cough and lung congestion since October. I finally got her to take albuterol inhalant treatments and the latest bout of wheezing is gone, but she's still congested. Should I expect to ever get rid of her congestion before the summer? If so, how? | |
| A | Cough and congestion in a pediatric patient is a very common and distressing problem. If she has not had chronic cough in the first 6-8 months of life, it tends to decrease the likeliohood of certain considerations, such as chronic aspiration (swallowing food into the wid-pipe, cystic fibrosis (often associated w/ a salty tasting baby and chronic diarrhea), and other uncommon conditions. Asthma, or Reactive Airways Disease, is a very common disorder in children under 5 years of age. We have learned a lot about its cause and treatment in the past 15 years. The congestion you're hearing probably represents ongoing inflammation (not infection) in her lungs. IF your child has been diagnosed with asthma or RAD, she probably needs ONGOING rather than periodic therapy. Our best therapies work, over time, to bring the condition under control, rather than simply treat the symptoms...this requires you to gain a better understanding of what you're dealing with (the disease), how to monitor it (what's going on; when do I need to worry; how much treatment do I give, and what therapies are most appropriate for her (guided self management). Make SURE she avoids exposure to smoke. In allergically predisposed individuals, animal exposures (esp. cat) at this age can be very bad for later development of more chronic asthma. Try not to have her around other kids with viral infections (good luck!), and get treatment with a CONTROLLER medication (ask your doctor). This will help get her cleared up. It can be done! | |
| Answered by David Elkayam, MD, Allergy & Immunology, Bellingham, Bellingham Asthma Allergy & Immunology Clinic (3/20/2001) | ||
| Q | My daughter got RSV at the age of 4 months and she is now 10 months. My question is, could her lungs be scarred for life because of this illness she got? It seems like she's always catching colds, and when she does she always gets a bad cough. | |
| A | I wouldn't think it likely that the infection caused any scarring, but it may indeed predispose her to similar episodes of trouble with viral repiratory (RSV and other viruses)infections. About 25% of children have reactive airways with wheezing associated with viral illnesses in early childhood. The vast majority of these children outgrow their tendency to wheeze and have complicated URI's. Albuterol nebulizer treatments are often prescribed for this. If your child was a premie (less than 36 weeks), or had significant respiratory distress as a newborn (in a NICU), or has heart disease, then she should have the RSV vaccine monthly from November through April. You can greatly reduce the number of complicated or longlasting URI's by breastfeeding to age 1 year, avoiding smoke exposure and limiting your baby's exposure to people - especially preschool age kids. You might have your baby's doctor listen during one of these colds with a bad cough to see if nebulizer treatments for reactive airways is appropriate. | |
| Answered by David Miller, M.D., , , (3/14/2001) | ||
| Q | How can you get a child to take pills? | |
| A | By age 10, most children can do the "FILL, POP, GULP" method: First practice with water only: superfill the mouth to the point of chipmunk cheeks with the head tipped back. Next, swallow all the water in one giant swallow. When a child can do this, they are ready to pop the pill when their mouth is full and the head is tipped back and swallow all in one gulp. This way they won't feel the pill and separate it from the liquid as they have learned to do when eating cereal. | |
| Answered by David Miller, M.D., , , (2/12/2001) | ||
| Q | Can a diagosis of "GERD" (acid reflux) in a 5-month-old baby possibly be accurate? I know this may sound wierd, but this is what I am being told by the baby's doctor. It sounds outrageous to me. | |
| A | This is at times a very appropriate diagnosis for an infant, and certainly not uncommon. This can be present right from the time of birth. All infants have a naturally "loose" opening between the esophagus and the stomach, so food and stomach acid come up much easier. Some infants have this occur much more than usual. The most common symptom is an unusual amount of spitting up, but symptoms can also include a cough, extreme irritability, or wanting to eat more or less than is needed. The treatment depends on severity and how much discomfort the baby has. Some infants throw up so much that they don't get enough to eat; others develop esophagitis, which is a severe irritation of the esophagus. By far the most common situation is a baby who is growing very well but who just throws up more than usual and may at times be a little irritable. Most infants without severe reflux outgrow this gradually in the first year of life. | |
| Answered at 1/12/2001 | ||
| Q | My six-year-old daughter has been having what I believe are night terrors for two or three years. At first she would just lie in bed crying with her eyes open but not responding to me, and finally I realized she was still asleep. A year ago she started to sleepwalk. When I wake up and find her (especially if she is crying hysterically), I would put her back in bed and try to console her but she would start shaking (usually her legs) and her arms would spring up into the air as if she were reaching out to someone She rarely, if ever, remembers these episodes. Will she grow out of this? Incidentally, she also has some kind of an allergy/eczema. She is constantly clearing her throat (usually from October through June), and she is itchy on her sides, inside of elbows, back of knees, etc. Could the allergies be connected to the "night terrors"? | |
| A | You have described typical night terrors. They are fairly common in early childhood, peaking in incidence at age seven and usually resolving spontaneously as the child grows older. It is not uncommon to see other sleep disorders such as sleepwalking, sleep talking, or bedwetting in the same children. The good news is that night terrors do not suggest underlying physical or emotional disability. Other good news is that they are usually easy to control with medication if the family considers them enough of a nuisance to warrant treatment. It is unlikely that you child's night terrors are related to her allergies, but both of these problems can be easily treated by your pediatrician. | |
| Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (11/20/2000) | ||
| Q | My daughter is only 8 years old, but I'm wondering if it's possible she could already be entering puberty. I have been noticing mood swings for the past five months, and it seems her worst behavior is during the same 5 to 10 days every month. I've also noticed that she seems to have a headache around the same time and that she sleeps much more or is tired more often. This is all very similar to when I first started my "time of change". She hurt her arm several days ago and needed my help to wash her hair. It was then that I noticed that she is already growing pubic hair as well. Is this normal for a child of 8? | |
| A | Girls are considered to be going through puberty prematurely if they develop breasts and pubic hair before the age of 8, so your daughter would not be considered abnormal if she were starting to develop. However some girls develop early pubic hair but do not develop breasts until much later. I would suggest scheduling an appointment with her physician to determine whether your daughter is starting to go through puberty at this time, or whether she just has early pubic hair. | |
| Answered by Lauren Herbert, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (10/27/2000) | ||
| Q | My 2 1/2-year-old daughter was born with her labia minora "fused." As our doctor expected, once she began walking and becoming more active, they have come apart some, but not all the way. Lately she has complained of pain in that area. It's hard to tell if she's really feeling pain or if maybe she's just becoming aware of having to urinate. She is not yet potty trained. Could that be the reason, or do you think she is feeling pain from her labia separating? I seem to remember the doctor saying it shouldn't be painful and it is just dead skin cells fusing them together. There is no redness or obvious irritation there at all. | |
| A | Labial adhesion is quite common in little girls, and is not generally painful. It often is caused or persists because of minor irritation that improves with a little extra attention to hygeine. Technique might include wiping "front to back", gentle washing with Dove or Lever 2000, then copious rinsing with clear water and drying well (hair dryer). Not using bubble baths, avoiding tights or wet swimming suits for prolonged periods also will help. If the labial adhesion seems uncomfortable, approaches 50% closure or is associated with vaginitis or uninary tract infection, we will often prescribe Premarin to help the adhesion resolve. I suspect your daughter's doctor would be happy to make this available if appropriate. | |
| Answered by David Miller, M.D., , , (7/19/2000) | ||
| Q | How can I help an 8-year-old boy handle his anger? When I tell him "no," he starts pulling his hair and hitting his head on the floor, etc. | |
| A | It is important to understand the motivation behind the anger. Children become angry for the same type of reasons as adults--thwarted wants and frustrations. Try to approach the situation that is causing anger as a learning experience for the boy. He wants something that can't be had in the way that he wants at this time. Try problem solving. Are there other things that would work? Are there other times? If it is food, are there other accpetable things that would take care of his hunger? If he can't have what he wants, how can he make himself feel better? Is there some other activity that would interest him, make him forget about the thing he wanted, or allow him to work out his anger in a constructive way? The goal of discipline is to teach the child how to manage him or herself and to be successful in situations. Look at anger as an immature attempt to solve a problem. The child needs to learn the next level of developmentally appropriate behavior to solve his problem. Is it the use of words? Actions? Self-soothing? It is easy to start a pattern of power struggles with a child where the object no longer becomes the issue. The issue becomes a parent saying "no" and the child not having his way. Try to avoid the use of direct confrontation and denial and try redirecting the child to another more acceptable solution to his problem want. Sometimes you need to use a time-out with the child to break the power stuggle pattern. The purpose of the time-out is to have the child learn what is acceptable behavior and what is not. It is not a punishment. The chld is removed from the situation in a calm and compassionate way, told what the problem with his behavior is and what could be done instead. Give solutions he can use. Let him know that when he thinks he can try out those solutions he can come out of time-out. There does not need to be an enforced time period to time-outs--only until the child gets control of himself and feels he can handle the situation successfully. | |
| Answered by Hallenburg, Kris S. PhD, , Springfield, PHMG/BHS-Spfld (4/18/2000) | ||
| Q | What is the best and safest way to treat children for head lice. I have heard that using tea tree oil in shampoo can reduce the chances of getting head lice; is this true? | |
| A | There are a number of options for treating head lice. The American Academy of Pediatrics Infectious Diseases Committee recommends permethrin (Nix) as the first medication, with lindane and malathion as other options. I do not use lindane because it is more toxic than the other medications, and have not used malathion because other options are available. As you probably know, Nix is used most commonly. The medication is approved for children as young as 2 months, and has been shown to be quite safe. One problem with Nix is that some head lice are becoming resistant, and the Nix treatment is ineffective in these cases. Options then are: leaving Nix on longer (e.g. overnight), using 5% permethrin, changing to another insecticide, or using an alternative method. Some of the alternative methods are very safe, but may not be as effective. One approach is to try to smother the lice with mayonnaise or vaseline. A second is to use an herbal product, such as Hair Clean 1-2-3. This is not FDA approved, but contains only coconut, anise, and ylang ylang oils. Evergreen Nutrition in Eugene has also helped some families make up a mixture of vegetable oil, thyme, and lavender to kill lice. I have had several families use these alternative regimens successfully. I have seen no studies using these methods (except the Hair Clean). Because these methods are not well studied, they are not the treatments recommended by the AAP. Important to any regimen is picking nits. I recommend picking nits daily for a week to make sure all are gone. The National Pediculosis Association recommends using the Licemeister comb (available at Walmart). I have heard very good reports about the comb from families and from people using the comb in school outbreaks. Clothing, bedding and cloth toys also need to be disinfected by machine-washing or drying (hot cycles). If these things cannot be washed, they should be placed in a plastic bag for 10 days. Combs and brushes should be soaked in hot water for 10 minutes, or washed in the Nix creme rinse. | |
| Answered by Lauren Herbert, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (1/20/2000) | ||
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