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Pediatricians answer questions about children's health
Pediatricians with the Washington state chapter of the American Academy of Pediatrics answered your questions about children's health.
Answers provided through the pediatric hotline are for information purposes only and aren't intended to supplant the physician-patient relationship or a professional medical examination. You should talk with your doctor if you have questions or concerns about your health or the health of a child.
2005 Pediatric Hotline physicians
Doctors who participated in the Feb. 2 Pediatric Hotline:
Bob Hauck
Mark Greenfield
Dianne Glover
Bill Schnall
Dick Dion
Roberta Winch
Steve Dassel
Jean Sahs
Joe Nakahara
Jeff Lindenbaum
Andrew Biles
Marie Bilger
Joanne Beaubien
Richard Gould
Mackenzie Smith
Taraneh Shafii
Jon Almquist
Varun Jhaveri
Bill Fournarakis
Rhonda Levitt
Sarah Weinberg
Katherine Runyon
Gordon Naylor
Rob Roskin
Jill Sells
Ruth Conn
Q: My baby was a preemie at 25 weeks 4 days and is still in hospital. From birth, he never opened his fingers till now. What could be the reason for his fingers staying closed? — Bellevue
A: Sometimes preemie babies take a longer time to do many of the things that full-term babies do. It may be that if the baby was still in the womb, his fingers would have remained closed until now as well. Some premature babies are at risk for muscle problems as they get older. Although it is difficult to know if the delayed opening of your baby's fingers might indicate that he, too, might have muscle problems, he will need to be followed closely once he goes home by pediatricians and therapists.
Q: My 4-1/2-year-old son is a very, very picky eater. He has gone to bed few times without eating dinner and sometimes sleeping through the night. My question is: Should I be concerned and start giving him vitamin supplements? He weighs about 43 pounds and is 43 inches tall. He won't touch any vegetables or fruits. He'll eat rice, chicken and mac and cheese. We limit his junk-food intake. What should I do? — Renton
A: Most important is his overall growth curve (which your pediatrician has). Is he overall growing along his curve? If so, nothing more needs to be done. If he is crossing growth percentiles in the wrong direction (e.g. was at the 5oth percentile for weight and is now at the 10th percentile for weight), then your pediatrician will need to intervene.
Assuming your son has been seeing his pediatrician at least yearly, your pediatrician would already have intervened if this was an issue. As long as he is growing normally, you just have to accept that you have a picky eater. No vitamin supplements are needed. I would still work on trying other fruits or vegetables to increase his diet variety.
Q: My 10-year-old daughter was recently diagnosed with Osgood-Schlatter disease in her knees. She plays basketball, soccer and track. Is it important to cut back on physical activity now to keep it from getting worse? Or should we let her continue with her sports and treat with ice and ibuprofen as needed? I know many tendonitis overuse injuries can become chronic, so I'm concerned she'll be plagued with this for many years if we don't nip it in the bud. Also, will one of those patellar straps help? Thanks! — Redmond
A: For an initial flare, it is good to now lay low for a week or so and treat with round-the-clock ibuprofen (three times/day) for a week. This will help to "nip it in the bud." After this, you can then change to activity as tolerated and ibuprofen as needed. If the pain recurs to a significant extent again, do the same one-week routine of little/no activity plus ibuprofen.
Q: Is there a natural way to treat ear infections for toddlers without using antibiotics? — Kirkland
A: Unless an ear infection is causing significant problems (high fever, extreme irritability) usually antibiotics are not necessary. Even if there are symptoms, one can watch for a day or two and let nature (i.e. the body) heal itself, especially since most ear infections are still caused by viruses for which antibiotics do nothing. Auralgan (an ear drop used for pain) is sometimes helpful for the ear pain in addition to Tylenol or ibuprofen. If, however, the fever and pain continue for more than two days, it is a good idea to then consider antibiotics, which will lessen the course for ear infections caused by bacteria and help prevent rare complications of ear infections.
Q: My child, who is an 8th-grader, has a problem of anxiety. Where would you recommend we go for testing and treatment for the anxiety? — Bellevue
A: I would start with your pediatrician. If your pediatrician feels this is an excessive problem, then he will recommend a psychiatrist or psychologist.
Q: My 16-month-old son weighs 19 pounds, 15 ounces and is 30 inches tall. It was recommended that we continue to feed him formula instead of whole milk, and when we do switch to whole milk, we should give him vitamins. Do you agree with keeping him on formula? When we do switch to whole milk? Which or what kind of vitamins should we give him? — Renton
A: I do not agree with keeping him on formula. I would switch him to whole milk. If he is having a good variety of foods (fruits, veggies, meats, dairy), he does not need additional vitamins. I would limit his whole milk to 3 cups a day so that most of his calories come from solid foods, and I would give him solid foods that are high in calories. It might be useful to see a nutritionist to help you with planning a high-calorie diet; ask you pediatrician to recommend one.
Q: I am a 14-year-old girl, I am 5' 8", and I weigh 100 pounds, so I can never find clothes that fit. I eat a fair amount of food, which is healthy, but I don't know how to gain weight. How can I do this and still be healthy? — Issaquah
A: To look at this problem in a reasonable way, I'd need to know what you eat and how much you exercise as well as more about your general health. If you have not seen a pediatrician about this, it would be a good place to start to be sure you don't have any problem in how your body uses the calories you eat. There are illnesses that make it impossible to gain weight despite adequate calories. If you are otherwise healthy, you should be able to eat enough calories to gain some weight in a healthy way. This would usually mean including healthy fats, proteins and carbohydrates in a balanced way. Not all fats and carbs are unhealthy. Your weight may be, in part, genetically light but based on height your ideal weight would be around 130. Please think about taking this issue to your physician or a nutritionist for specific help.
Q: My 8-year-old has very big tantrums always revolving around her 3-year-old sister. We just had a big fight and everyone went to their rooms, but my daughter bit me and hit me. Help me! — Seattle
A: Certainly sibling fighting is a common problem, and sometimes a difficult one, especially since it is often difficult to know who got the fight going. I've certainly seen many younger siblings who know exactly how to push the older child's buttons and get them going. However, I am concerned that an 8-year-old would bite and hit you. That should not be allowed at any time. I have a feeling if it has come to this intensity there is not a quick fix because you need help in setting limits with your daughter and commanding her respect. There are good books about discipline that may give you some guidance, such as "1-2-3 Magic" (by Thomas W. Phelan) and "Siblings Without Rivalry" (by Adele Faber and Elaine Mazlish), but I think you should ask your pediatrician or family doctor to refer you to a child psychologist who could help you with the problem in a more hands-on way.
Q: I have 9-1/2-month-old twin girls. They have slept through the night since they were 9 weeks. However, they have always been bad nappers. They are able to fall asleep on their own. Since they have learned to sit up, they've been "conversing" with each other instead of napping. They also wake up early and cannot go back down. If I leave them to fuss, they eventually wake their sister up. Separating them is difficult in our small house. How can I get them to sleep, and more important, keep them asleep? They are also very light sleepers. When the phone rings, they wake up. Did I make them this way? They have a "blankie" and I play lullaby music. Putting them down at night is so easy; daytime is such a chore! An hour nap is fabulous! Any other napping tips you can give me would be fabulous! — Seattle
A: Do the twins sleep in the same crib? If they do, maybe a little separation would help. Sometimes babies who haven't napped well begin to establish at least one nap in the 9- to 12- month period as they become more active. It sounds as if you've done a great job with bedtime. You might want to wean them off the lullaby music if they fall asleep to the music, as that becomes an integral part of falling asleep and may be necessary to getting back to sleep. Is there any way to have the older sister in a separate place so that you can let them fuss back to sleep in the morning? You don't say how long they sleep at night. If they go down early and wake up early but are sleeping 12 hours, they may only need an hour during the day. Hope some of these ideas help. If not, you might check www.aap.org (Web site for the American Academy of Pediatrics) for more information.
Q: I am an older mother and one of my children had "night terrors" for a period of time. We found that if we put her on the toilet, it knocked the "terrors" right out of her. Maybe it will work with someone else. — Seattle
A: I wonder if the familiarity of the toilet helps to calm or if sometimes the child just needs to go to the bathroom!
Q: My son often starts coughing at night even before he goes to lie down. He coughs even when he doesn't have a cold. And he frequently wakes up congested but then is fine after being up and around for a while. Should I be concern about the possibility of asthma? He has two cousins who have very acute asthma. — Bellevue
A: Yes you should be concerned about asthma. Other concerns for asthma besides nighttime cough and family history include prolonged cough or wheeze associated with respiratory infections or cough/wheeze associated with cold weather, weather changes, dust, pets, or after exercise. Have him see his pediatrician.
Q: My 26-month-old son is frequently constipated. Although we make sure he eats plenty of fibrous foods (he loves salad!) and drinks lots of fluid (mostly water/apple juice mixed and milk), he continues to have this problem. I think that because it is painful to have a BM after three to five, he is afraid to go … and so it becomes an endless cycle. We have tried giving him "Little Tummies," a natural laxative; it doesn't always do the trick. Also, the bottle says not to continue use after seven days, and this issue has been going on for months. Is there another remedy or a prescription we should know about? I want to resolve this issue before we start potty training! — Seattle
A: First of all, make sure you are dealing with constipation. More important than how frequent your child has a bowel movement is what the stool looks like. If it is hard, then he has constipation. If it is soft, he probably does not (although there are exceptions to this). It sounds like he is getting a good diet. One other thing I would try is prune juice. Some kids don't like the taste, so mix it with 7-up or Dr. Pepper, but try to have at least 1 cup of prune juice a day. If that doesn't work, there are many prescriptions that he could try for which he would need to see his pediatrician.
Q: My son's father has sleep apnea. Most nights he snores so loudly he startles the baby in his bassinet. Now I am beginning to notice that my 3-month-old son is snoring. Should I be concerned that he will develop sleep apnea as well? I understand that it can contribute to SIDS (sudden infant death syndrome). — Auburn
A: If your son's snoring is soft, don't worry. Sleep apnea is unusual in a 3-month-old but is definitely seen in older infants (older than a year) and children. If you notice periods where your son stops breathing for longer than 10 seconds, or if the snoring is so loud that you can hear it outside the room with the door closed, a sleep-apnea evaluation might be indicated, and you should see your pediatrician. It is true that sleep apnea can contribute to SIDS, although the biggest contributor is sleep position … thus always put your son on his back or side to sleep and never on his tummy.
Q: My 9-year-old granddaughter since age 2 does not eat any fruits or vegetables and only eats chicken breast, tenders, bacon and pepperoni. Cheese is only eaten on pizza or quesadillas. She is now getting chubby with a large belly and a double chin. Other than the obvious weight gain, how is this unhealthy diet affecting her health on the whole? — Renton
A: If she continues this pattern, she will likely become obese at a very young age and be at risk for the same issues as adults with obesity: type 2 diabetes, early cardiovascular disease (heart disease, strokes), obstructive sleep apnea (which can cause heart-muscle strain over time and problems with attention during the day), hypertension/high blood pressure (which can cause kidney problems, eye problems, and heart problems), high cholesterol, etc. Unfortunately, we are seeing more and more kids who are having high cholesterol and/or hypertension and/or subtle or obvious type 2 diabetes … problems that used to be solely adult problems. Even if your child doesn't develop these problems now, she greatly increases her chances of these problems as an adult. Now is the time to intervene. The therapy is age-old: Decrease the fats and sugars, and increase the exercise. A few simple things: Don't change how much she eats, instead change the quality of foods she eats; decrease the amount of juices and milk (only 2 cups of milk a day, including with cereal) and increase the amount of water (also try Crystal Light); decrease TV/computer/Nintendo time (no more than one hour a day); increase the number of fun outside activities (emphasis on fun).
Q: I was wondering what other things would be recommended for babies (especially under 1 month) who have regular bouts of gas. Currently, I give our 3-week-old Mylicon drops when he is especially distressed with gas pains. However, I would like to have other options that might make him more comfortable when he is feeling gas pains. He does turn red, scrunch his legs, and grab hold of my hand when the pains hit, so I know he is hurting. Sometimes these pains flare up off and on for several hours. Thanks for any advice! — Woodinville
A: If the Mylicon drops work, use them, but my experience has been that they often don't work. Sometimes spending more time burping helps. Others have found that rubbing the tummy or doing hip exercises (flexing/extending/opening/closing) helps.
Q: Hello, I am 15 years old, and when I turned 14 (after many tests and diagnoses) I had to have my gallbladder removed. After the surgery even until now I haven't been able to eat as much and have to use the restroom a lot more than before. Do you have any suggestions about what I should eat or do about this? I thought that after surgery I could start to eat more fatty foods again, but it seems like I can't. — Lynnwood
A: Unfortunately, once people get their gallbladders removed, they often have a problem eating the same amount of fatty foods that they used to eat, since the gallbladder helps digest fatty foods. My suggestion is to decrease the amount of fatty food you eat. Sometimes it works to eat smaller portions of fatty foods, but with more frequent portions (so the total amount is the same). You shouldn't have problems with other foods.
Q: My son is 3 years old, and he is uncircumcised. What care should I be giving? Also when does the skin pull away from the penis? My doctor told me to start pushing down the skin; I have tried, but nothing. Am I doing something wrong? — Puyallup
A: The only care necessary is to pull the foreskin back as much as you are able and then clean whatever areas is exposed whenever you bathe your son. Otherwise, no daily pulling back of the foreskin is necessary (apart from hygiene). Most foreskins will eventually loosen on their own. The timing is quite variable, but often it is fully retractile by the teen-age years. If the head of the penis is irritated or if there is any pain, see your pediatrician. In extreme cases, there are steroid creams that can be placed to help loosen the foreskin, but rarely is this needed.
Q: My son will be eight in a couple months and still wets the bed at night. He usually wears a pull-up because I just don't have time to wash his bedding every day. He's dry about a quarter of the time. We don't let him have liquids for an hour or more before bedtime, and he always urinates before going to bed. He's a very heavy sleeper. Any suggestions? — Seattle
A: Restrict liquids for a longer time before bedtime. There are some commercial bedding alarms that sound at the first moment of liquid touching the bedding that help train some kids into waking up. If that doesn't work, there are also some medication options that you could try … see your pediatrician if interested.
Q: My 17-year-old son was at a dermatologist recently and was told he has non-specific dermatitis on his hands. The finger pads are extremely painful, a bit scaly, smooth to the point of losing his fingerprint impression, and appear to lack fluid (the pads are very flat especially on the thumbs). The ointment, Lidox, hasn't helped. Could soaking or anti-fungal spray help? With what type of doctor should he follow up? He's getting quite discouraged. This started about five weeks ago, but he hesitated about seeing a doctor thinking it would go away. The doctor he saw asked if it itched (it doesn't) but may not have realized how much pain there is! Thank you for your help! — Woodinville
A: Without really knowing what your child has, the only other thing I would recommend is good skin hydration like Eucerin or Aveeno lotion. From your description, it doesn't sound like an anti-fungal spray would work. For discouraging rashes, most pediatricians would refer you to a dermatologist, which your son has already seen. Try following up with the dermatologist again or ask him to refer you to another dermatologist if you are interested in a second opinion.
Q: What is the cause of SIDS (sudden infant death syndrome)? — Kansas City, Mo.
A: There are several hypotheses and likely the cause of SIDS is multifaceted. The rates of SIDS has dramatically decreased since pediatricians have begun recommending that all newborns up to 4-5 months always be placed on the back or side to sleep and NEVER on the tummy. Thus one very likely cause of SIDS that is being effectively dealt with is sleep positioning with babies placed on their tummies having a higher risk of suffocating because of their position. Another cause is babies getting stuck between the mattress and the edge of the bed (make sure there is no space between the edge of the mattress and the bed). Less common causes include sleep apnea, babies that have suffered some sort of brain injury (during pregnancy, birth, or afterwards), respiratory infections, meningitis, rare genetic diseases or rare metabolic diseases, etc.
Q: My 3-1/2-year-old is exhausting me as she kicks, screams and cries every morning when I drop her off at school. As a working parent, this is a terrible way to start the day (for both of us). I should mention that in the last six months she has become a big sister to a 1-1/2-year-old girl from China. While I know a lot of the morning "trauma" is about adjustment to her new sister, what steps can I take to help her get through this challenging time? — Seattle
A: She is likely having difficulty adjusting to two new events: school and the new sister. Remember to continue spending quality time with her so she doesn't feel left out. Sometimes having her "help" you with the little sister can also be rewarding for her. Her reactions are normal and some patience will be required as she slowly adjusts to these big changes.
Q: My son has been complaining of leg pains for the past several days. We went for a long hike over the weekend, and I don't know if he is just sore or if it is something more serious. He has had problems with foot cramps in the past, but we were unable to find any medical cause for them. Please advise. — Seattle
A: Given the recent long hike, I would suspect that the pains are just from the hike. Another common cause is growing pains most commonly seen in the middle-school and high-school years. Leg pains that are concerning, for which you should bring your child into the pediatrician, are those associated with any redness or swelling of the legs or joints or pain that is waking your child up in the middle of the night. Otherwise, try some ibuprofen or ice packs. For the next four days have your child take ibuprofen three times a day around the clock to help with any inflammation that might have happened because of the long hike.
Q: Our 3-1/2-year-old occasionally gets leg cramps or pains, mostly at night, usually around the knee area and sometimes in his feet. I've heard this is probably growing pains, but I wanted to know if that sounds correct. When would it be considered anything more serious? — Mountlake Terrace
A: Growing pains are extremely common, and he is the right age for them. They are usually at night. The key is whether he is able to be active without any pain, limping, swelling or other leg complaints during the day. Then he should not have any pathologic problem that needs to be further evaluated.
Q: My 3-year-old niece exhibits many of the traits of autism. Her mom, my sister, downplays most of her tantrums, inability to communicate, lack of fear as just being part of her personality. It's time for a diagnosis -- what is the best way to get her diagnosed? And how should I approach my sister with the information? — Camano Island
A: To diagnose autism, I'd consider talking to the child's physician. In Seattle, for further evaluation, there is the Autism Center at the University of Washington, and the Neurodevelopment Clinic at Children's Hospital.
Q: My son has neurofibromatosis, which he got from me. He is 3 years old and does not speak like other 3-year-olds in his day care. My doctor says there's no connection. I want a second opinion. What do you think? — Redmond
A: Neurofibromatosis may have many presentations, but your son's speech delay is probably not related. He should have a speech evaluation if he is delayed or has a severe speech impediment.
Q: My 6-year-old daughter frequently complains of soreness on her bottom and/or genital area. The areas are often red, so I usually treat them with A&D Ointment after she bathes. I suspect she is not wiping correctly but am wondering if allergies could be in play here? — Seattle
A: There are a number of reasons for a sore bottom. It could be that she is not wiping completely, but few girls do. Soaps and bubble bath can be irritating, so a bath with minimal soap -- but lots of soaking -- is an idea. Loose clothes and not sleeping in underwear is useful to 'air out' her parts. Pinworms can cause itching and redness around the anus or vagina and are frequently impossible to see in her stools or on her bottom. They crawl out of the anus at night and lay eggs which causes itching. They are about 1/4-inch long and there is an effective medicine for them. Masturbating, which all kids do, can also cause irritation. She could be sensitive to your laundry detergent or laundry additives.
Q: My son just turned eight months old and he's starting his phase of separation anxiety. During the day, when he's playing, how can I leave him so I can get a few chores done? Also, at night, he's waking crying ... almost screaming. Do you have any suggestions on ways to cope with this issue? And how long does it last? — Edmonds
A: If possible try to do some of your chores in the presence of your child. Also try to keep your child interested in something when you try to leave him. Unfortunately, he is still likely to cry and you will have to just accept the crying. Separation anxiety usually starts around your son's age and can last until 1.5 yrs old.
Q: My fiancé's 4-year-old daughter has constipation resulting in withholding her bowel movements and soiling her underwear while playing. During the three months she was predominantly in our care we would give her 1-2 teaspoons of Milk of Magnesia a day (as needed), but eventually we no longer had to. Changes in her diet (increased water and fiber consumption) resolved the constipation. Now that she is back in her maternal grandparents care, she is "pooping her pants" again. They refuse to use Milk of Magnesia and even frown on increased water. The child says she is afraid of getting in trouble and is evidently withholding her bowel movements again. Our suggestions have been rebuked. Please advise us on the proper solution for childhood constipation. Hopefully, the information provided by the pediatricians with the Washington State Chapter of the American Academy of Pediatrics will provide an agreeable resolution for all family members and for his daughter. — Kent
A: The fact that the Milk of Magnesia worked to solve the problem is important. Kids who soil are most often constipated and treating the constipation is of primary importance. There are lots of stool softeners, and Milk of Magnesia is commonly used and safe. More fluids, increased fiber in the diet are important, as well as establishing a regular time to sit on the toilet. Some experts recommend sitting for 10 minutes after every meal to try to go. Talk to the child's doctor, too. It's a long-term problem that will need ongoing attention.
Q: Our 5-week-old son makes horrible grunting noises on a 30-second interval while sleeping. I have heard this is normal. It is so loud I cannot sleep in the same room with him, and even using a monitor is difficult. When does an infant's sleep "normalize" so that it becomes less disruptive to others? — Everett
A: Noises during sleep are normal. Grunting often is from passing gas or having a bowel movement. As long as he seems OK, is eating and sleeping well, it's OK to watch. When do noises stop? No specific time.
Q: Our 26-month-old daughter still uses a pacifier. Do you have suggestions for breaking her from this? What is the recommended timeframe to do this for our future reference? — Everett
A: I usually recommend that kids stop pacifiers between 6 and 12 months, so, obviously, we've missed that opportunity. Stopping it for older kids is hard. Probably the best way to stop (besides just getting rid of it, which does work) is to try decreasing the use of the pacifier gradually. Try having it not available, or even seen, for two hours each morning. After about a week, try extending the time by another hour, and gradually increasing. Getting it down to just at bedtime would be a good goal to consider.
Q: My soon to be 7-year-old son has been having underarm odor lately. What could this be, and can we have him use deodorant? — Lynnwood
A: Some kids have underarm odor earlier than others. If, in addition, he's showing development of underarm hair or pubic hair, have him seen by his doctor. Deodorants are OK if others are noticing. Look for teen products.
Q: My 15-month-old granddaughter does not walk independently yet. She can stand for a few seconds and push a stroller. Her GP said to wait another month. She's in the 93rd percentile in height. Any suggestions? — Seattle
A: Some kids don't walk until 17 months or so. The fact that she's able to get to standing and walk holding on means that she really is able to walk, but just isn't comfortable enough to let go. Kids usually walk holding on for about two to three months until they start letting go.
Q: I have an 11-month-old granddaughter with eczema. She scratches so much at night we cover her hands, or her skin would be raw. She is better if we use the cortisone 1 percent, but we are concerned about the long-term effects of that on thinning her skin and the systemic effects. Is there any other way to control the itching, especially at night? She wakes up itching and needs to nurse to go back to sleep. Her parents have her sleep with them so they can comfort her and keep her hands covered and keep her from rubbing her head on the linens, etc. She was tested for allergies at about 7 months and found to be allergic to dairy, wheat, etc., so her mother has been avoiding all of those items in her diet. She continues to breastfeed. Is there a pediatric doctor who specializes in this area? Should we be taking her to the Mayo clinic? Would it be better to stop breastfeeding? If so, what type of milk would you recommend? Any chance she will outgrow her allergies and eczema? — Bellevue
A: Eczema, or atopic dermatitis, can be miserable. I would not be worried about the systemic effects of 1 percent hydrocortisone cream since there is minimal absorption. However, there are prescription creams and ointments that work the same and are not steroids: Elidil or Protopic. Have her parents ask the baby's doctor about these. Sometimes the baby needs even stronger steroid creams on the most involved area ... applied to the worst areas only.
Benadryl, Claritin, or a prescription antihistamine called Zyrtec or Atarax could be used to suppress her itching. These are all liquid antihistamines that block itching, and the Benadryl and Atarax also make the person sleepy so should be used at night.
If she has food allergies, which are hard to test for at her age, then breast milk is good for her. However, if mom is eating or drinking the foods she is allergic to -- like milk or even perhaps nuts -- then she may have an eczema flare-up since cow's milk protein can be in the mom's milk. So mom should avoid dairy. It may be that she is not allergic to any foods but just has eczema.
Also, avoid any chemical exposure to her skin, such as fabric softeners or any laundry additives, and use laundry soap without fragrance. She may need more bathing or less bathing, but avoid any soaps with fragrance. A good soap for her skin would be Cetaphil. Good luck.
