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Pacific Northwest Magazine

Q & A: Pediatric hotline

A pediatrician answered a selection of reader questions about children's health online.

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.

Q. My 17-month-old absolutely refuses to drink milk. We've tried soy milk, rice milk, powdered milk, whole, lowfat, anything with the word milk in it and he just spits it out. Is it a problem if he never drinks milk? We try to supplement his calcium intake with yogurt and cheese and calcium fortified foods.
— Jennifer, Seattle, WA

Some kids are just not milk drinkers. As long as they get other calcium sources, it shouldn't be too much of a problem. I'd keep trying off and on, as milk is an easy source for getting lots of calcium. Sometimes trying chocolate (or strawberry) milk works. If you can get him to drink that for a while, then you can gradually reduce the amount of chocolate powder over time, eventually getting back to plain milk.

Some kids are sensitive to lactose. They feel bad when drinking milk, and they learn to avoid it. Sometimes they do better with other milk products such as yogurt and cheese.

Q. My son is almost 7 years old. He continues to have at least one tantrum, almost every day. This behavior occurs only at home. In school he is the perfect student. What should we do? We thought he would grow out of it.
— Linda, Seattle, WA

A. Tantrums are fairly common in some kids. It's good that he is doing well in other aspects of his life. You've probably heard that behaviors that are ignored tend to disappear and behaviors that are paid attention to persist. I usually recommend ignoring tantrums, saying something like "I can't understand you when you're upset. Let me know when you're done and we'll talk then," and leaving the room. Hopefully, when he realizes you're not in the vicinity, he'll stop the tantrum and come find you.

Q. I have a daughter who is 14 years old. For the past several years she has had problems when she goes No. 2, she ends up plugging up the toilet almost every time. Is there something we can do?
— Sally, Seattle, WA

A. This sounds like she may be constipated. Try to increase the fiber and fluid in her diet, so stools are softer and more frequent. Nuts, dried fruits, and whole grains would be a good place to start.

Q. My daughter (nearly 8) has an aversion to taking medicine of any kind. Our pediatrician has switched us to 3-dose Zithromax for ear infections (which thankfully we haven't experienced in over a year), but my child will gag and spit some of it up. Same problem with liquid Motrin or Tylenol, and she refuses chewables. She claims she hates the taste of all of it. Now we need to start vitamins for low iron. My wife has had some limited success by bribing our daughter with small gifts for taking her meds when ill, but it's getting tiresome. Any other suggestions or tricks of the trade?
— Stuart, Seattle, WA

A. I was the same way. The vision of a spoon of that pink Amoxicillin could make me vomit when still inches from my mouth. Many 8-year-olds can learn to swallow pills. Have her practice with a small candy she likes, such as TicTacs. I learned to swallow pills by coating them with ice cream. Good Luck!

Q. My 10-year-old daughter has frequent severe headaches. They just seem to grab her without warning. Is this a common occurrence? Could it have anything to do with puberty? Both my mother and I have always had headaches as well. Mine are food-related I have learned, as well as related to hormone fluctuations.
— Debbie, Shoreline, WA

A. Headaches are something that your daughter should be seen about. There are lots of causes of headaches — fatigue, muscle tension, migraines, tumors. Headaches that are stable over many months without progressing in severity or frequency are less likely to be worrisome, but still need evaluation. Migraines are fairly common, more often in girls and can run in families. They are usually the more severe types of headaches. If she hasn't seen her doctor, it would be a good idea.

Q. My 3-month-old son is drooling already and chewing on his fist. Could he be teething already? He was sleeping for five hours at a time for a week, but now he is back to sleeping two hours at a time. Is this sleep pattern normal when babies are teething?
— Leanne, Seattle, WA

A. Biting and chewing constantly are normal 3- to 4-month-old milestones, and have nothing to do with teething. He is learning to coordinate his lips and tongue, and practicing this all the time. Sleep is variable at this age — he may be having a growth spurt and need to eat more frequently.

Q. My 11-month-old daughter has had allergies since she was born. Are there any allergy medications or treatments for a child this young?
— Theresa, Phoenix , AZ

A. Do you mean constant runny nose or wheezing when you say allergy? Many children under a year seem to be congested "all the time," and it is actually infectious rather than allergic. Antihistamines can be used in infants, but of course can be sedating or cause irritability. I would rather you sort out whether or not this is actually an allergy, and to what she might be allergic to (avoidance is better than medication at any age).

Q. I am concerned about my 9-1/2-year-old son who recently started telling me he was seeing a lot of white, black or colored dots in his visual field. He has also described them as flashing or blinking lights. He says this is more noticeable to him in a dark room, although he can see perfectly. I took him to a pediatric ophthalmologist who dilated his eyes, and he had a normal exam with no eye problems. When he was 4, my son mentioned this once, and now he reports this experience has occurred from time to time. Since last week this is happening continually. What is going on? Should he see a neurologist for further testing? Or should we just watch him and hope this goes away? I have never heard of this and would appreciate any information. Is this commonly reported by children? Besides this, my son is healthy.
— Louise, Sammamish, WA

A. He might just be noticing the lights and dots we all see in the dark, and mentioning it. Blinking lights or dots can be a precursor to migraine headaches, so if he is getting headaches, this should be evaluated.

Q. What are the primary indications of a child having ADD (attention deficit disorder)? What are the current typical treatments and what new things are being tried? Is this a lifetime condition, or do children grow out of it?
— LA Rivera, Chehalis, WA

A. An estimated 5-10 percent of children have ADD (or more correctly ADHD -- attention deficit hyperactivity disorder). There are three forms, the Inattentive form, the Hyperactive/Impulsive form and the Combined form. The inattentive kids have a hard time focusing, remembering, completing tasks, following instructions. The hyperactive kids fidget, climb excessively, intrude on others, can't sit still. The diagnostic criteria say that symptoms need to be present before 7 years of age, and affect more than one aspect of kids' lives (for example, home and school). Other conditions may mimic or accompany ADD, such as anxiety, depression, or oppositional problems. The problem seems to be a problem with chemicals in the brain called neurotransmitters. Medications are usually used, new ones are being introduced. If this is truly a chemical problem, it may be a lifelong condition. Studies show that about a third of kids with ADD who are treated eventually don't need medications. That still leaves two-thirds who do.

Q. We're desperate for solutions for our 5-year-old son who doesn't want to stop activity/play to have a bowel movement. Instead, he soils underpants and remains silent until picked up from kindergarten. Several doctors have had him on stool softeners for over a year so he can "feel the need to go." We believe this is a power-control issue. The child is content with the smell and feeling of dirty pants. He was successfully potty-trained at age 3-1/2. He had behavioral set-backs after two family cross-country moves at age 4. X-rays show that 30 percent of his stool remains in his colon after 1-year of medication. Why won't pediatricians identify the problem and help us solve this instead of just prescribing stool softeners? How do you inspire someone to want to keep their own body clean?
— Power Struggle Parents, Seattle, WA

A. It may be a "power-control" issue, but it's his, not yours. Stooling can be a very difficult issue. The mainstay of treatment does involve stool softeners, but if he is still backed up, he needs a more vigorous medical "clean out" before behavioral treatment can work. There are therapists who (believe it or not) specialize in this condition. Ask your doctor for a referral to a therapist who treats encopresis.

Q. How do you get a child to want to seek help for possible depression or mood disorder. My 13-year-old daughter will not acknowledge any problems with her feelings, moods, sadness and general lack of happiness. She is not interested in help or diagnosis. What do we as parents do to encourage her to be a part of the process of getting help?
— Denise, Mercer Island, WA

A. If she is showing significant signs of depression — withdrawal from activities, school problems, irritability, cutting, weight loss, etc. you need to seek help for her with or without her cooperation. As parents, you should consult a therapist who can help you arrange it and persuade her to give it a try.

Q. My 13-month-old son prefers soy milk to cow's milk. What are the benefits and/or detriments of soy milk for toddlers? Should I offer my 2-1/2-year-old daughter soy also? Is cow or soy milk better for them?
— Tanya, Seattle, WA

The biggest problem with soy milk is that it's generally nonfat and we usually recommend not restricting the fats in kids less than 2. That's why most people recommend whole milk until age 2. If kids can't drink cow's milk, trying to add fats in other forms — mayonnaise, butter/margarine, dressings may be appropriate. I don't think there's any data on which is more healthy. Cow's milk has been standard for so long, it's probably most appropriate for those who can drink it.

Q. My 3-1/2-year-old wakes up crying about 80 percent of the time. He does this when he hasn't gotten his fill of slumber, from trips in the car, from naps when we have to wake him up to eat or to go somewhere. What can we do to prevent/avoid this?
— Manny, Seattle, WA

A. Some kids just wake up fussy. It may be helpful to discuss this with him, even at this age, during the day when he's not crying or before going to bed. Certainly, praising the times he wakes up not crying is a good idea. Does he fall asleep out of his bed and then feel scared when he wakes up in his bed? If so, you could try having him fall asleep in his bed so he's familiar with it when he wakes. Also, try not to reward his fussiness. Get him up and doing normal activities without spending excess time comforting or worrying.

Q. My granddaughter Rhea who is 8 months old cannot sit up on her own. When we make her sit, she will do it. Also, she hasn't gotten any teeth yet. Is there a problem with her?
— Ramani, Washington

A. An 8-month-old should be able to sit if placed in a sitting position, but getting to a sitting position by herself is a 10-month-old skill. Teething is irrelevant. There are many healthy children with zero teeth on their first birthdays.

Q. Our granddaughter, age 9, has a severe fear of the wind and gets hysterical when the storms bend the tree branches. We assure her she's safe with us, that if we were in danger we wouldn't be at the house, but she is unable to be calmed until she falls asleep. She keeps referring to being on her Dad's boat during a windstorm and how she got terrified then and can't help it. We are so sad that we can't calm her. Any advice on how she can get past this?
— Sybil, Renton, WA

A. Kids often have an experience, or even something like a dream, which may be scary and then get generalized to other experiences. It's important to continue to be reassuring and show her, by your actions, that you're not afraid. Counseling would be quite appropriate for this problem.

Q. Our kindergarten son, an only child, believes he is in charge. He becomes angry and frustrated when he doesn't get his way with meal choice, free time and family activities. We parent in a happy, peaceful home, calmly displaying polite behavior and manners. We demonstrate "speaking words" to solve disagreements, rather than yelling and shoving. Only after temper tantrums, plus a five-minute cool-down does he consider the consequences of losing privileges. We need to tame his temper. "Time outs" sometimes diffuse it but are not a solution. Any strategies for "earning privileges" with best behavior, vs. removing playtime, fun activities?
— Ready for R-E-P-E-C-T, Seattle, WA

A. You may be expecting too much at this age. He is learning, and as you describe, able to calm down. Your management is very appropriate, and your example of calm politeness is best. Star charts are a tried-and-true method to earn privileges, but you must set up small-scale, easy-to-achieve rewards to get it going. He also may need a "cool down" time before he is in full tantrum mode — early intervention will help him recognize his state when there is some chance of self-control, before he completely loses it.

Q. My 2-1/2-year-old is generally a pretty well-behaved kid, but he terrorizes our smaller dog by chasing him, trying to sit on him, and trying to play with him more than our dog would like. Nothing terribly malicious, but we just can't get him to leave the dog alone. Our dog is now showing signs of behavior issues. Do you have any suggestions as to how we can get him to give our dog more space?
— Wendy, Seattle, WA

A. It would be appropriate to separate him from the dog when he does something inappropriate. I'd state the behavior that you don't approve of ahead of time, like "Don't chase Fido" or "Being rough with dogs can hurt them." Then if he chases or sits on the dog, pick him up, state the rule firmly, and then set him down and walk away from him for a couple of minutes. Generally kids don't like to be ignored. If every time he hurts the dog, someone tells him he did something wrong and then withdraws attention from him, over time, the behavior should go away.

Q. Is it safe for children as young as 2 years old to eat honey?
— Steve, Auburn, WA

A. Honey is not recommended under one year because of the small risk of infant botulism. After that, it is safe, but of course is like sugar so should be quite limited.

Q. My husband and I have 11-month-old twin girls. The girls were born full-term and totally healthy. They had been doing really well eating solids, happily gobbling down the pediatrician-recommended amount of food every day. Within the past couple of weeks though, it has become a different story. They are suddenly resistant to solids, particularly fruits and veggies, and don't seem content in their highchairs. I read that at this age babies want to be more involved so I give finger foods as much as possible (cheerios, cheese cubes, peas and carrots, diced fruit, which is slippery and hard to pick up -- etc), but they eat so slowly there is no way they would get a full serving in one sitting. I have also given each baby two spoons to bang on the tray etc. while eating (one puts the spoon in her mouth with each bite I give her). I also read food consumption can decrease at about a year, but that is a month away. They each only have two bottom teeth, but more are currently coming in. Is this a teething issue (how long can teething issues last?), a developmental issue, a general issue? How long do I let this go on before going to the doctor? They are still consuming recommended amounts of formula.
— Melissa, Edgewood, WA

A. At this age, normal children do not allow their parents to participate in feeding them. Give them all finger foods, and sit back. Your job is to offer healthy foods, their job is to decide how much to eat. After a year, their milk intake should go way down, and solids will be more of their total calories.

Q. Hi, our son is a cancer survivor and will turn the big 13 in a matter of weeks. We are concerned about the long-term effects of chemo and other cancer-related drugs. He seems smaller than many of his friends and frankly, he has a temper. His grades are mediocre, and we are worried about his future. (Will he be able to father children? Will he be able to rein in his temper? Can he attend the college of his choice if he learns effective study skill.) Overall, he is healthy, and of course we hope the leukemia will not return (he had acute lymphocytic leukemia and was treated from age 2-1/2 to 5-1/2). Any insights you might have would be appreciated.
— Sam and Alan, Bellingham, WA

A. This is a very important and growing area of study in Pediatric Hematology and Oncology. Children's Hospital in Seattle now has a program for long-term follow-up of survivors, dealing with all your concerns. If you are unable to get to Seattle to that clinic, contact them, and they will help your local doctor with the recommended follow-up tests and guidelines.

Q. Is it OK to use antibacterial gel or wipes to clean up a 1-year old's hands?
— Corene, Seattle, WA

A. If soap and water are not available, it's OK, but good old-fashioned soap is an effective antibacterial and perferred for regular use.

Q. I have had trouble finding a "foreskin-friendly" pediatrician for my sister's newborn -- that is a doctor who knows that the membrane connecting my nephew's glans and foreskin can persist as long as 17 years without a worry, and who will not forcibly retract him. I know that the American Academy of Pediatrics forbids forcible retraction, but it seems few physicians know this. Do you have a list of pediatricians in the Northwest who understand this medicine as well as European doctors do and who will respect my nephew's normal development? What should I tell my sister to do?
— John, Seattle, WA

A. I would hope most younger pediatricians would know better. It might help just to ask on the phone whether or not the doctor approves of circumcision before making an appointment. Your sister could copy some information from a book for her doctor if she likes the doctor otherwise, but feels education on this one topic is needed

Q. My 2-1/2-year-old son has suddenly, in the past week, cried and clung to me when I leave him at daycare. He's been going to the same place for over a year and usually loves it. His father and I, recently divorced, are having legal problems related to child support. I always talk to my son about his daddy in a positive tone, but I doubt if the same happens at his dad's house. To make it even more difficult, his father remarried weeks after our divorce and now my son has a ready-made step-family complete with another boy just a bit older than him. My son loves going to visit his dad but is exhausted when he returns. It takes an hour to get him to bed at night (this has been going on for a month since he got his toddler bed) and recently, if he wakes up, he comes into my room and wants to sleep with me. I'm so tired and worried. Can you help me?
— Worried Single Mama, Seattle, WA

A. You are doing the right things by keeping your schedules and routines the same. This will be a difficult transition for your son, but calm and firm support and reassurance are what he needs. Don't let him get in bed with you, but allow him to sleep on a mat on the floor next to you. That way, he gets the reassurance that you are there (after all , Dad is no longer there), but the situation is not so disruptive to your sleep. Slowly (over weeks) you can move the mat farther across the room from your bed. If he is not showing signs of adjusting better over the next month, consult your regular doctor.

Q. My 8-year old has two large, stubborn plantar warts on her feet. We've been using over-the-counter salicylic acid for months and have been to the doctor numerous times to have them shaved and frozen. Recently she suggested using cantharadine plus. I'm looking for a second opinion before saying yes to this medication. Would you recommend this treatment?
— Caryn, Shoreline, WA

A. I use canthardine and canthardine plus frequently for warts in my office. Thicker warts on the foot respond better to the stronger form. It can be left on overnight, or if it's too itchy or uncomfortable before bed, washed off then. It usually causes a blister that separates the wart from the normal skin, killing the wart. It's easy to apply and not too uncomfortable. It's much less painful than freezing the wart off.

Q. I have an 8-year-old son who throws up before school a couple of days a week. It happens right after we get his coat and backpack on each day. I have taken him to the doctor who found nothing physically wrong. My son says he is not being bullied at school, but he is nervous about his school work. My son does throw up occasionally other times when he gets nervous. My question is, is there something I can give him to calm his stomach so we can make it out the door or should I consider taking him to a child psychiatrist? Thanks.
— Kim, Seattle, WA

A. This could represent something we call school phobia. Kids sometimes get nervous enough to have physical ailments when stressed. If it's only prior to school, not other times in the day, not on weekends, it may simply be nervousness about going to school. It is important to make sure he goes to school, unless he is obviously ill. Talking with a child mental-heath specialist (social worker, psychologist or psychiatrist) would be appropriate. As far as things to give to calm his stomach, you could try simple things like a Tums tablet.

Q. My 11-year-old step daughter and her brother, 6, sleep in their mother's bed every night. My step daughter has expressed to both her father and me her embrassment over this and her desire to sleep in her own bed. She is very concerned about what her mother will say and how she will react. Let's just say "guilt and manipulation." Is there a way we can empower her to make this move and to feel good about taking charge of her own life? She will be in middle school next year and is deathly afraid that other kids will find about this and ridicule her. Mom is not willing to listen or discuss this issue with anyone. Any suggestions??
— Jane, Federal Way, WA

A. Definitely a hard issue for your stepdaughter. Certainly at this age, if she's feeling uncomfortable, some changes are in order. She could talk to her mom possibly saying that she knows that all off her friends sleep in their own beds and that she'd like to try it, too. She could mention that she doesn't sleep very well with the others in the bed. The mother may have needs to have her children close to her, but hopefully she'll be able to listen to her daughter.

Q. My active 10-year-old won't stay in bed at bedtime. He's always up within a half hour or so, complaining that he can't sleep. We explain that his body needs to settle in and that standing up, wandering around, and then knocking on our bedroom door aren't good ways to relax. We usually put him to bed about 9-9:30, and his alarm goes off at 7:30. We let him read if he wakes up. Is he trying to get more attention? And how can we help him find ways to settle in?
— Joanne, Seattle, WA

A. Lots of kids don't seem to want to sleep using the schedules that we think they should. In general, if he gets enough sleep to be active and happy during the day, he's getting enough sleep. As far as his nighttime wandering, I usually recommend making rules that kids don't need to be asleep in their rooms when they go to bed, but they need to stay in their rooms and not bother anyone else in the house. Also, I'd make sure there isn't a TV in his room or any other major distractions.

Q. I have a 13-year-old son who is suffering from a severe eczema and hive problem. He is taking Claritin everyday, and I don't know how harmful that is for him. Any advice on safe medication and helpful lotion/ointment will be helpful.
— Sally, Bellevue, WA

A. Eczema is a vexing problem for those who suffer with it. We always recommend moisturizers liberally applied many times a day. Vaseline is probably among the best -- also Eucerin and Aquaphor. It should be something fairly greasy, not a lotion. Applying a moisturizer immediately after a bath is very important. Steroid creams used intermittently are very helpful. Newer prescription "immune modulators" such as Elidel and Protopic are also good. Talk with your son's doctor.

Q. Hello, I would like to know if you have any idea what causes my 2-1/2-year-old niece to wake up in the middle of the night crying and because her right leg hurts. It has happened at least a couple of nights since last week. She pointed to the knee area. We found that there are no red marks or anything indicating her knee is swollen. Do you have any idea what is causing her pain?
— Bich, Renton, WA

A. This is something I'd have her seen for. Nighttime pain may be as simple as "growing pains," although she seems a bit young for that. Pain like this can also be associated with some tumors or leukemia. I'd have her doctor evaluate her.

Q. We have a 2-year-old girl that we adopted from China last year at this time. She has suffered from chronic constipation since her first day with us. It occurs several times a month, and she is in lots of pain accompanied by cramping, sometimes for hours before she can have a hard BM. She enjoys and eats lots of fresh fruits and vegetables every day. She's a voracious eater, which probably developed from orphanage survival tactics, but she's calmed down a lot recently. She is in the 95th percentile for weight for her age, big and muscular but doesn't appear overweight. I've been giving her 1/4 cup of prune juice with some water added daily which seems to give her relief and regularity. Is this something to be concerned about? Other than that she is very happy and doing well and is healthy in all other respects.
— Casey, Issaquah, WA

A. Constipation is fairly common in kids. At this age, when kids are getting close to potty training, it's important to make it as easy as possible to go without discomfort. As kids learn how to control their bowel movements, if they're worried that it will hurt to go, they can also learn how to keep the stool in, leading to long-term problems. Using prune juice is a great idea, and even more of it and not diluted would be OK. The only hazard of too much prune juice is diarrhea, so you can keep increasing the amount to whatever works. Continuing good dietary habits are important. Talk to your child's doctor if problems seem to get worse.

Q. At what age can I expect my almost 4-year-old twin girls to be able to settle down better for bed? They must share a room for space purposes. They work so hard to wind up and keep themselves awake for one to two hours after bedtime unless we are in the room until they fall asleep. We have an early bedtime, they don't care about lost movies/stuffed animals, etc., for consequences. They usually sleep 10-12 hours. Any ideas to promote sleep behavior in the preschool child?
— Kristin, Edmonds, WA

A. Sleep issues are a frequent question for physicians. The usual advice, which I'm sure you've tried, is to start the bedtime sequence a while before the time you want your kids to go to sleep. Bathing, getting into sleep clothes, reading (calmly) starting maybe 30 to 60 minutes before going into their room. It sounds like consequences aren't going to be useful. Their total amount of sleep sounds good, and I assume they're not too drowsy during the day. I expect that over time, things will calm down a bit. Good luck.

Q. My daughter is 14 months old and has always had a difficult time pooping. Now that she's been on real food for a while, the poops are normal, but before they happen she is frantic -- wants to be picked up, put down, throws down toys, just cannot be placated. And then when it finally comes, its scream-fest time. She'll hang onto you and bend double and scream, grunt and groan. It's very distressing for us to see her in apparent pain, and we worry and wonder whether there's something that we can do to help her. The past couple of weeks we've tried soy milk instead of whole mile because of something I saw on the Web that sounded similar. Our doctor says as long as there's no blood, then she's fine. It just doesn't feel fine letting her continue to scream and get upset everytime. Can you help?
— Lisa, Seattle, WA

A. Dietary changes would certainly be appropriate. Trying soy milk may be worthwhile. Although soy milk products may not have enough fat for children her age, excess fats seem to be associated with constipation. Other foods that are helpful, as long as they are easily chewable, include prunes, plums, pears, almost all vegetables, and bran products (muffins, breads, etc.) Prune, pear, and apple juices are reasonable as well. There is a fairly new stool softener, by prescription, glycolax, that is easy to use and dosage adjustments are simple. You might ask your doctor about it.

Q. Our 7 year-old daughter is still experiencing occasional night terrors. These seem to occur most often when she's fighting a virus; while I'm told they are not harmful, I'm wondering about frequency and severity of the thrashing. We have experienced two incidents during the same night, and some fairly violent arm, leg and head movement. Is there anything special we can do to ease her into more restful sleep during times of illness? Also, can we expect her to "outgrow" this soon?
— Diane, Seattle, WA

A. Night terrors are fairly common, usually starting about 3 years old and stopping by about 8 or so. I have had one patient, however, who still was experiencing them in his teenage years. They are harmless, although you need to be aware of safety issues with getting out of bed and wandering. They are also more common with illness, fevers, etc. Experts suggest trying to ensure enough sleep and talking about calming things when putting kids to bed. Something I've recommended to parents: If you know about the time the night terrors occur, try to wake your child briefly about 10 minutes before the episode happens. This seems to head off the terror. In general, since the kids have no recollection of these episodes, it's much worse for the parents.

Q. Our family adopted a little girl from Shymkent, Kazakhstan, in late April of 2004. At the time, there was a question about her true birthday. The day we met her, the orphanage told us that she was 7 (she looked about 6 or 7), a week later, she told us she was 8, then a week later, after court, we were told that she was 9-1/2!

At her SOS clinic exam in Almaty, Kazakhstan, she was 48 inches (4 feet) and 55 pounds. We came home, did physical/dental assessments,and assigned her the age of 8-1/2 yrs old, (one year younger than her "documents.") The first year home, she grew 6 inches, put on 20 pounds of muscle mass and bone density, but, my concern is that, last Nov, she started her monthly cycles ... not surprising, as this was after significant growth, breast growth, and other signs of rapid puperty approaching. My concern is, is it "too soon" in that, she is now 56 inches tall (4 foot, 8 inches) and 92 pounds. She does have her 12-year molars, so she may be biologically older than 10, but do I need to be concerned with her height growth stopping? Thank you so much for any information that you can give me!
— Karla, Sequim, WA

A. It definitely sounds unclear as to the real age of your adopted daughter. In my experience, refugee children frequently have inaccurate birth dates. In terms of body development and sexual development, for American children, it is now felt that early body changes may start as soon as 8 years. Your question about eventual height and cessation of growth is important, as you know that the greatest growth occurs in early puberty and slows afterward. I'd discuss this with your daughter's doctor. Evaluation by a growth specialist, checking hormone levels, "bone age" X-rays of her wrist and changes in height over time may help with this question.

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