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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?


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?


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!


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?


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?


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?


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?


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!

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!


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 (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.


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.

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!


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).

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?


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!

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.


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?


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?


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!


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?


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.


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.

Q: My 5-month-old goes to bed between 9 and 10 p.m. Is this normal? Every time we try to get her to bed earlier she wakes back up and doesn’t go down for the night until 9 to 10. We would love to get her in bed by 8, but don’t know how (we do not want to have her cry it out).Ferndale

A: That is not such a bad time for her to go to bed. If she is sleeping well once she is in bed, I would not force her to bed earlier. She also may wake up earlier if you make her sleep earlier.

Q: My 5-month-old old has just started eating rice cereal. She seems to really enjoy it and seemed ready for it (hungry and not satisfied after breastfeeding). I am curious what kind of limit I should put on it. She seems like she would keep eating as much as I feed her. Should I limit her to 1 tablespoon or give her a little more if she seems to want it?Ferndale

A: You will find that you can give her more — a few tablespoons maybe twice a day and that should not affect her breastfeeding. Too much cereal can cause constipation. I am sure over the coming weeks you will introduce other foods, and she will enjoy them too.

Q: What is your recommendation for how often infants/toddlers should have well-baby exams? Our insurance only covers five exams during the first year and then only one per year.Issaquah

A: Ideally, a baby should be seen for well-baby checkups at 1 to 2 weeks and at 2, 4, 6, 9, 12, 15 and 18 months, and at 2 years. Sometimes the 15-month and occasionally the 9-month visits are skipped if there are no concerns, and the immunizations could be given at other visits. It would be very unusual for your insurance to have such a limited number of visits.

Q: Over the past eight to 10 months or so, my 17, almost 18, year old son has had problems with his skin breaking out (not huge epidemics of acne, just unpleasant boil-y looking pimples). He pretends this doesn’t bother him, but he washes his face a lot, maybe two or three times in an evening when his skin has broken out. I thought skin problems were more common in earlier adolescence (his skin was fine ages 12-17). Also, does washing his face — he uses plain old soap and water — aggravate or help? We eat a very healthy diet, lots of fruit and vegetables, and have always done, so I can’t point to any changes to what he’s eating.Seattle

A: There are advantages to acne-specific soaps over ordinary soaps, so he should use these. He should also be using topical creams on his face or where the acne is. Over-the-counter creams containing benzyl peroxide may be helpful. Also, there are prescription creams, gels and washes that may work better. He may be a candidate for either an antibiotic cream or perhaps a pill to eliminate the acne. You should consult his doctor if over-the-counter remedies are not working. He is not too old to be getting acne. People into their 20s still suffer from acne.

Q: How much protein does a 12-year-old need to eat per day? My son has an aversion to most protein (chicken, fish, beans, etc.), and I am concerned he is not getting enough for proper growth.Seattle

A: I don’t keep specific numbers in mind for protein intake. Interestingly, the U.S. intake of protein far exceeds that in most of the rest of the world. Protein deficiency is exceedingly rare, except in starvation conditions. I wouldn’t go too crazy about it. Vegetarians eat a lot less protein than everyone else and still are healthy. Keep trying small amounts.

Q: I’m a single mother with a 4-1/2 year old son who has been potty trained since he was 2-1/2. His preschool teacher and father insist on putting him in pull-ups for naptime preventing him from wetting his clothes. I however have not used pull-ups for nap at home since he was 3-1/2. He stays dry at home, however I have not been able to persuade his father and preschool teacher to quit using them. We’ve had quite a fight over this and I feel that all of this is just confusing my son.Everett

A: If he’s dry at your house for naps, and he stays dry in pull-ups at dad’s and day care, he probably doesn’t need to keep using them. If he’s wet at dad’s and daycare, it probably won’t cause any harm to keep using them. Generally, letting kids be wet in order to teach them to stay dry doesn’t work too well. Check with the other caregivers to see if he’s really wet when he’s with them.

Q: My daughter is 7 months old and lately she has been cranky and throws up a lot and has diarrhea. But she eats normally and plays normally. It’s just when she doesn’t feel good, she really does not feel good! Is she starting to teeth, you think? What are the signs of teething and what are the symptoms of discomfort to a baby of this age?Edmonds

A: Unfortunately, when that age baby is cranky, ANYTHING can be wrong. Teething does occur at this age but is usually well-relieved with Motrin or Tylenol — you can try that for a day and see if it makes a difference. If you have introduced new foods, that can also play a role. You might need some specific help from your pediatrician.

Q: I have a 21-month-old who has had a cold for a few weeks now. He has a bad cough and cold medicine does not seem to be helping. He also has a running nose and it’s starting to get thick. Last night, he had a low fever. He has had a sinus infection before but I’m not sure if he has one now. What is the best medicine to give him for a cold? We have been giving him Dimetapp and it helps a little but it makes him drowsy and he has to go to day care tomorrow and I would like to give him something that will make him feel better but won’t make him tired. Any suggestions?Bothell

A: Colds can go on for a week or two. Sometimes kids get two colds in sequence so it can seem to go on even longer. Sinus infections are generally colds with persistent thick nasal discharge and cough that goes on two weeks or more. Cold and cough medicines are generally not very useful. They will not cure the illness, shorten it, or keep it from getting worse. They offer (thought not very well) temporary decrease of symptoms for three to four hours. There’s not one brand that’s any better than others. Dimetapp has an antihistamine along with a decongestant. Antihistamines are usually more for treating allergies, not colds. You might try just a decongestant. Kids can get fussy with almost any cold medicine.

Q: My 19-month-old daughter has had a few ear infections following colds, which I understand is common. However, she gives us no indication that she has one. No ear tugging. No fever. Nothing. We have only discovered them when we brought her to the doctor for different issues. They send us home and say to bring her back if she spikes a fever or acts as if she were in pain. OK. I’m not a huge fan of antibiotics at the drop of a hat, so this works for me. The doctor doesn’t seem to want to recheck my daughter’s ears at some later point to make sure the infection has cleared up. My question is: How are we supposed to know if the ear infections actually ever go away? How do we know that each time they diagnose an ear infection, that it isn’t the same infection that didn’t clear up?

A: Good question. However, it is unlikely that a kid will keep an ear infection for weeks and weeks. They CAN keep “fluid” in the ear for months in a row, however. It is very simple for a pediatrician to check the ear to be sure the infection or other prob lem is gone so the next time you know it is a new one. You do not have to treat every infection either but if it causing her pain, that is a good reason to treat. If ear infections persist or there is lots of fluid, you MIGHT be able to notice that her hearing is not as good as in the past.

Q: Hello, 1. My 6-month-old son is already 20 pounds, and only eats 30 oz formula a day and just started 1-2 tablespoons of rice cereal two weeks ago. I wonder if there is concern for any hormonal problems? His thyroid check at birth was normal. Any type of concern/workup you would suggest? 2. Because he is a big guy, he spits up easily when sitting up (pressure from his filled tummy). He has been spitting up more over the past two months. Any concern of a mechanical problem causing this like a hernia, growth or other?Seattle

A: I would not use cereal ever. It has too many calories and is unnecessary for nutrition. If he wants or is ready for solid foods, use vegetables — less calories and “healthier”. The spitting up is not a problem unless he thinks it is — pain, etc. (It can be “reflux” but that doesn’t need treatment without pain either.) If his thyroid test at birth was normal, it is still normal now.

Q: My 10-year-old son has little white bumps, like whiteheads, on his face, under his chin and on his chest. This has been going on for at least two years. Our family doctor said it is just a virus, and has tried burning off the biggest ones on his chest. They take a long time to go away, then new ones appear. I have never seen another child with this before. Could it be a reaction to the chewable vitamin C tablet he takes daily? Thank you for your opinion.Kirkland

A: It is definitely not from the vitamin C tablets. What your physician MAY be thinking of is “molluscum” — look that up on GOOGLE and see if it looks like what HIS looks like. In that case, they DO last a long time. They are a relative of the wart. A pediatric dermatologist could help further clarify this.

Q: My 22-month-old baby has had a diaper rash for three weeks. We tried hydrocortisone as the doctor told us but it did not help. Is there anything else that can help my daughter get over that rash?Bothell

A: If the hydrocortisone did not work, it MAY be a yeast infection needing a prescription medication. You should also keep it as dry as possible by using a medicated cornstarch product.

Q: My 5-year-old son has been relatively healthy until recently. He’s had coldlike symptoms (runny nose, occasional cough) for quite some time (several weeks) which don’t seem to go away. At night, he has difficulty sleeping. It sounds like has problems breathing (sometimes sounding gurgly). Some nights are better than others but it’s not normal. He’s also lost a few pounds. We’ve taken him to his doctor who suggested having his adenoids removed or that he may have allergies (dust mites, etc.) She gave us some asthma chewable tablets to see if that would alleviate the problem. It’s too early to tell but it doesn’t seem like it has any effect. Can his condition be a sign of something worse? My husband and I are worried.Seattle

A: The suggestions your doctor made seem reasonable. Tonsils can be evaluated visually, adenoids need either an X-ray or a flexible scoping by an ear/nose/throat specialist. Trying the asthma medicine (Singulair?) seems like a good idea. Considering an allergy medicine would also be something to think about. The weight loss bothers me some. If it’s related to these symptoms versus normal weight loss that happens off and on. Have his doctor involved regularly.

Q: My 11-year-old daughter is 4’11” and weighs 124 pounds. We are very concerned about her being overweight but also very concerned about her getting an “eating complex” if we don’t approach the subject with her correctly. Do you have any suggestions or can you recommend any resources for how to talk to her about developing healthy eating habits?Bellevue

A: You might want to think about seeing a wise pediatric nutritionist. Your pediatrician should be able to show her, on a graph, where her height, weight, and BMI plot out — which would be “factual” data as opposed to “opinion”. Of course, if SHE is not motivated the results will not be as good. You don’t mention puberty but that can be a potent issue in this arena. Keep on the subject for the health of your daughter.

Q: My 7-year-old daughter still wets her bed three to four nights per week. We always tell her not to worry about it but we are starting to have a hard time taking that advice ourselves. Any suggestions or resources that you can recommend?Bellevue

A: Presuming she has been doing this for years there is no disease that can be involved. While 10% of 5 year olds and 5% of 10 year olds still wet, that does not make it easy. There are medications for use in this problem as well as excellent bed-wetting alarms. If you haven’t spoken to your physician, you should.

Q: My 5-month-old baby sucks her thumb. She has done this for a while and I have heard it can effect her speech and the shape of her mouth. She has been sleeping much better since starting this but I am concerned. Should I be doing anything to stop this habit or will she naturally grow out of it?Ferndale

A: Thumb sucking is very common and at 5 months will not cause significant problems NOW, but this could become a habit problem in the future. It would be better if she would suck on a pacifier since you can throw that away later. You might not be able to convince her to substitute one for the other. Don’t worry too much. When she is older (like 18-24 months) you can work on the thumb. It will not affect her speech or mouth shape in the first 18 months, for sure.

Q: My baby girl is 3 months old. She falls asleep around 9:30 at night. She always cries, really screaming from nowhere around 15 minutes to 45 minutes after we put her in bed. Is there any reason?Kirkland

A: If she cries and either stays asleep or goes right back to sleep then it is not a problem at all. There could be LOTS of reasons but none of them are significant. If she is waking up and needing lots of “help” going back to sleep, you will want to talk to your pediatrician about that.

Q: My niece is 3 months old and was born with hydrops, as well as having a stroke before being born. I am concerned right now about her eyesight. She doesn’t seem to focus on you, even when you are right in front of her. Do most of these cases see this? How likely is it that she will see fine? Also, she has just now built up enough shoulder strength to push herself up off the floor. Her legs are very stiff, too. Some say it is the stroke; other professionals say it from the swelling at birth and will go away. We are hard at work with her therapy. Is there more we can do? Any insight at all is appreciated. Can you tell me some things to watch for, or to prepare for.Boise, Idaho

A: I can appreciate your concerns; she sounds like a complicated patient. I am not able to give specific answers. Regarding her sight, she should have a special vision test to determine whether she is visually impaired. It is possible with a stroke to have damaged the part of the brain that processes vision. One test is called a visual evoked response (VER’s) and an impaired baby who does not seem to focus or follow an object should be evaluated by an ophthalmologist and probably get this test.
Regarding her motor skills, she is just 3 months old and has a lot of potential development. She should be in a physical-therapy program. I am sure her parents appreciate extended family support.

Q: Our son is 17 months, and he doesn’t really say any words at all. He says “no,” and occasionally we’ll hear “mama” or “dada” but it’s unclear whether these are directed at either of us. He does babble a lot, understands quite a number of words, and can follow very simple directions (like bring me the toy). But is his lack of spoken words still within the normal range?Redmond

A: There’s a wide range of speech skills at this age. Often I suggest parents write down all the words that kids are saying, then put that piece of paper in a calendar page. Four months from now, if there is no change, I’d talk to his doctor and consider a speech and/or hearing evaluation.

Q: My 8-year-old son’s ears turn bright purplish red from time to time. Always his left ear, but sometimes both ears. This happens two to three times a month. He has no fever, and no other symptoms. No doctor has been able to tell me why. Can you?Seattle

A: I don’t know if I can tell you why, for sure, either but color change always has to do with blood flow. So the real question is why does he have variable blood flow to his ears. It is common in cold weather situations but even if it happens in other situations and there are no other circulatory issues, I surely would not worry about it. If you want to pursue it further, a vascular physician would be the best resource.

Q: How toxic is ingested styrofoam for a toddler? What amount is worrisome?Seattle

A: I do not think ingested styrofoam is toxic at all. I would worry about choking and other gastric disturbances, however.

Q: I have a 20-month-old granddaughter who is getting very picky about what she eats. Mainly fruits and veggies. Very little meat. There are days where she won’t eat a thing. She loves milk and juice and seems quite happy and content. She’s showing no signs of illness. Her height and weight are average for her age as well. I know toddlers can be finicky one minute and not the next. However, I don’t recall my own kids being this extreme. This same child refuses to take naps on some days, and if she does take one, she wakes up crying in the middle of the night and won’t go back to sleep. Is this normal?
No city

A: It sounds like she is eating OK but for meat. Some toddlers do not like the texture of meat. Fish or tender chicken sometimes works better. Also, if she is drinking a lot of milk or other dairy products, she may not need much more protein. Keep offering her new foods, and make sure she is hungry when she sits down to eat.

Regarding her sleep behavior, it’s good to be consistent so she knows what to expect: the same nap time if possible, and keeping her in the crib if her parents want her to sleep through the night.

Q: Our 10-year-old son is having frequent leg pains — sometimes so bad he can hardly walk in the mornings. He’s seen a doctor, who first diagnosed growing pains and shin splints (he’s grown an inch in two months) and, when that didn’t get better, we took him in again for X-Rays. They saw a spot on the tibia of his right leg (which does seem to hurt a little more than the left leg) so yesterday he had a bone scan, which turned out to be negative. He’s quite sensitive to pain, so it’s hard to tell how much is pain (which we know is genuine) and how much is his reaction to the pain. The pain does get better after a time in the morning and comes back (not as severely) in the evening. It seems worse on days after he’s done a lot of walking. We will be seeing an orthopedist in the near future, but in the meantime, how can we help him feel better? What are some of the other possibilities of what is going on with him? His older brother had precocious puberty and grew very rapidly, but our younger one is so far not showing accelerated growth (he’s tall for his age, but not off the chart as his brother was).
Federal Way

A: You are well on your way to a complete workup, which may NOT reveal anything. But the other thing to look at are his FEET — flat feet often cause leg cramps and pain and can be alleviated by orthotics. You can buy them under the brand name of Spenco or Superfeet in most sporting good stores. If it is both sides, it assures you it is nothing “bad.”

Q: My 1-month-old grandson has developed some sort of trouble in between feedings. (He was like this a little in his first weeks but it seems to be getting worse.) He is fine immediately after nursing, but then within 15-30 minutes he starts grunting and turning red and is in obvious distress. He often lets out a high-pitched screech that sounds like intense pain. He dozes off and on through this sometimes but seems to sleep fitfully, often waking in pain. One of my children had colic, but she screamed a lot, not like this, and was hard to comfort. Could this little boy have colic and just be tough? Or could this be acid reflux which so many babies are getting diagnosed with? Thanks for any help.

A: I doubt this is colic as you describe it. It could be acid reflux. An easy diagnostic approach is to keep him elevated 24/7 — in a car seat, for example, and see if he is better. Additionally, he could have a problem with the valve in his rectum, anal sphincter we call it. Does he seem to have any problem passing stool? That can be clarified with a one-minute visit to the physician for a rectal exam. He could be eating too fast and getting lots of gas. Again, sitting him up would help, with a warm water bottle on his stomach. His pediatrician should be able to clarify these things.

Q: How do I get my 8-year-old daughter to stop sucking her thumb? She is a very responsible independent fourth child. She seems to suck her thumb when she is relaxing at home or in the car.
Federal Way

A: I do not know what you have tried so far, but here are some general recommendations: Give her something else to occupy her hands, like a squishy ball to hold at a time when she would be sucking her thumb. There are compounds like nail polish you can buy that have a bad taste, and you can paint them on her thumb. Give her a sticker when you notice she is not sucking her thumb, and let her collect 10 stickers then get a treat. Paint her nails with some great polish, and tell her that thumb-sucking will rub it off. There are many other ideas. You could talk to her doctor or dentist. She may have dental problems based on thumb sucking so ask your dentist.

Q: My 10-month-old has always put anything in her mouth, but she also likes to gnaw on things like a wooden railing or the hard plastic on the side of her high chair. We had to put something around her crib rail because she was scraping off the paint. She also grinds her teeth (she has her first eight). Yesterday she rubbed them together so hard it sounded like they were breaking up into pieces in her mouth. Could this be a sign of some problem? And any advice on safe things to give her? She shuns soft plastic things and shreds hard plastic and wood to bits!

A: This behavior is probably normal at this age. Most kids like to chew on almost anything. I’d just make sure that what she chews on is safe. Tooth grinding is also normal, and, to my understanding, there’s no relation to vitamin or mineral deficiency. It’s OK to ignore the grinding. At this age, it shouldn’t cause any problems.

Q: My older son has ADHD (attention-deficit/hyperactivity disorder) and is 20 years old. He is at Western Washington University for his second year. He has been on ADHD medicine since second grade, and has been under the care of a pediatrician. But now the pediatric nurse is recommending he switch to a family-practice doctor because of his age. When and how do you make the transition of care for the ADHD child that grows into a young adult?

A: Doctors who care for adults are becoming more aware of ADHD in their patients. Your son and you can be referred by the pediatric nurse or by his pediatrician to a family-practice doctor or internist who can take over his care. You could call the new doctor’s office to discuss their comfort level with ADHD medical management. Good luck.

Q: I was surprised when my daughter said her baby’s doctor told her nonfat milk was OK for her 20-month-old. When she was a baby, whole milk was recommended. Have the guidelines changed? I am concerned because their family eats a very low-fat diet — little or no meat, cheese, margarine or butter, and no junk food. They drink very little milk. Second related question: My daughter and son-in-law believe that people who are on lower protein diets require less calcium than what is recommended in the guidelines because ingesting protein makes the body more acidic, and it requires extra calcium to neutralize the effects. What are the protein and calcium guidelines for children on vegetarian diets?

A: To my knowledge the protein and calcium requirements of children are NOT different if on vegetarian diets. As for the non-fat milk, the “party line” is that it is OK after 2 years. Some people will say 18 months but that is based on the concept that there is other fat available in the diet. FAT makes brain growth. If they are amenable to the suggestion, there are good nutritionists at Children’s Hospital who are familiar and sensitive to the vegetarian perspective of families while still providing optimal nutrition to the child

Q: Our grandson is not quite 1 month old. He seems very healthy and has surpassed his birth weight of 10 pounds. However, he does infrequently turn bright red and seemingly holds his breath. Giving him a pacifier corrects the problem. Is there cause for concern and is there anything else we can do?

A: Breath holding voluntarily is common in older kids, but not at 1 month. Certainly, he could be uncomfortable, trying to have a bowel movement, etc. It’s expected that he’ll get red in the face when these things happen. All probably normal, but watch for any other problems.

Q: What can I do to keep my 2-year-old from getting constant colds in day care? I have heard of giving children edelberry extract, Airborne tablets and herbal extract. Any suggestions?

A: There is no convincing data on any herbal products for preventing colds/illnesses. Also, there is very little research on the side effects of these products in children. We know clearly that kids in day care get sick much more than kids at home. The usual stuff about good hand washing, covering your mouth, etc., are the best methods.

Q: Is there any way to get my 21-month-old son to sleep through the night without letting him cry? He has only slept through once or twice and usually wakes up between one and four times. He is in a toddler bed, so it is more difficult to address now that he isn’t in a crib. I work full time and it is so hard to forgo sleep in order to try letting him cry it out. He is an incredibly happy, outgoing boy during the day and naps well. We have an established going-to-sleep routine, which unfortunately includes me staying in his room until he is asleep. Is there a magical age when most kids start to sleep through on their own without crying it out?
Maple Valley

A: Sleep problems are very common. How he goes to sleep at night really determines how well he sleeps during the night. If he could fall asleep by himself every night, his middle-of-the-night waking would probably go away. Crying to get this solved may be the best way, and could only take a few days to a week or so. You probably know about Richard Ferber’s book, “Solve Your Child’s Sleep Problems.” It’s a classic with good information. “Guide to Your Child’s Sleep,” by George J. Cohen, is a newer reference. You could try slowly moving farther away from his bed gradually over a month or so until you are out in the hallway. Sometimes it works. He’ll probably outgrow this, but it could be years.

Q: I have a 13-month-old daughter and she seems to get yeast infections on her bottom frequently. After a bowel movement her bottom will get very irritated and then a yeast infection will develop. Her pediatrician recommended using clotrimazole. The cream seems to clear the infection up after a few days, but another one will develop. Is there something else I should be doing or could it be something in her diet?


A: It is uncommon for babies to get recurrent yeast without being on antibiotics. One of the questions is if Mom has yeast as a source of the recurrence. Talk to your physician about both of you taking a short course of Diflucan. Diet is unrelated!

Q: My grandson is 13 months old and has had numerous ear infections beginning at 3 months of age. He had an allergic reaction to Amoxicillin when he was 5 months old. He is on an antibiotic at the present time, and the family is heading to Hawaii next week. Is there a danger that his eardrum could rupture? Also, what is the best sunscreen for Hawaii for the baby?

A: Sunscreens need to be individualized. Try Johnson and Johnson “Water Babies” — but put a small amount on his abdomen today to see if he “reacts.”

On the way to Hawaii it is very unlikely that his eardrum will rupture — don’t worry.

Q: How can I find out more information about child immunization? I’ve heard passionate arguments for and against, and I am confused.

A: An excellent question which would require several hours of response. Speaking to your physician is a good first step. Reading on the Internet sites which “end” with “.edu” (not ending with “.com”) is also excellent. The Centers for Disease Control (CDC) in Atlanta has excellent information — “google” them. In general, immunizations have dramatically eliminated most serious/fatal childhood illnesses without long-term problems.

Q: I have a 3-1/2-year-old and a 1-year-old, and I have a question about both. My 3-1/2-year-old is afraid of everything. He’s afraid to go to the bathroom by himself (I have to stand in the bathroom with him). He’s afraid to go in his room, go upstairs by himself, etc. I have to go with him everywhere. He seems paralyzed by fear and I don’t know what he is afraid of. It is starting to wear on me because he can’t do anything on his own. This behavior has been going on for about a month. What can I do? My 12-month-old is experiencing separation anxiety I think, and she constantly wants me to hold her. I can’t leave the room without her having a fit. It’s hard to get anything done because she is always following me and crying for me to pick her up. Should I pick her up all the time or let her cry?


A: The separation problems are actually pretty common at these ages, although usually not quite so intense. For the older child, I’d wonder about what he’s been exposed to in terms of movies, movie previews, stories, videos, etc. Reassurance is helpful, but won’t solve the problem quickly. Being available when he needs you, but maybe standing farther away gradually — outside the door, a little way down the hall, etc. may be helpful. Be patient, it usually gets better.

One-year-olds sometimes will be able to be distracted with interesting toys, her sibling to keep her occupied while you are doing something else. When she wants to be picked up, try offering her something else while you’re in the same room.

Q: My daughter is 7. She’s had a cough for about a week, low fever at night for three nights, and complains of a sore throat for three days. Should I take her to see her doctor?

A: This could be just a simple cold; it’s that time of year. I expect colds to last a week or two, fevers for two to three days, sore throats a week or so. More important is how she’s looking. If she’s pretty comfortable, with no severe pain and breathing OK, it’s probably OK to watch a few more days.

Q: My 14-year-old, son, weighs about 85 pounds, and likes to work out. How much weight should he be lifting, for example bench press, bicep curls, flies and so forth? I am concerned that he uses too much weight.

A: Based on his weight I am guessing he has not started puberty yet, in which case working out with bench-press-type weight will not do him much good. Using weights (10 pound etc.) to increase muscle mass and stay in good muscle tone and shape will be good. The testosterone of puberty is what really changes fat to muscle and builds big muscles with weight-type workouts. He is probably not there yet. So he should not be lifting much. Remind him it is not the amount of the weight that matters now, it is the consistency of doing it daily.

Q: Our 9-year-old son has encopresis. We have been working with him using stool softeners and laxatives off and on for about two years now (in addition to trying to encourage him to eat more fiber in his diet). We see some improvement while he is using a laxative, but overall the condition doesn’t seem to be improving. We are extremely frustrated. Are there any alternative treatments? Could there be anything else going on? What are the chances that this could become so severe that it would cause a ruptured bowel?Seattle

A: Encopresis is a hard issue to deal with. Stool softeners, dietary changes, and establishing regular “sitting times” on the toilet (three times a day, after meals if possible) help. It’s a condition that needs frequent follow-up with your physician, every month or two. There is an Encopresis Clinic in Edmonds that is run by nurse practitioners previously at Children’s Hospital. They’re great, but insurance coverage is spotty. Good luck.

Q: Hello! Do you have any recommendations on any medicine that would help a toddler (1-1/2 years old) sleep while she has a cold? My little one gets all plugged up and can’t seem to sleep well. We have tried Benadryl but that had the opposite effect. I am looking for something like NyQuil, or Tylenol PM, but for toddlers.

A: That is not an easy question! But very common. She is probably not sleeping because her nose is so plugged up. Using a bulb syringe to suck out her nose before bed and tilting her crib so there is some elevation to her head could also help. You might try Dimetapp as a good alternative to the Benadryl. If desperate, there is a prescription medication called Phenergan with codeine that suppresses cough and makes kids VERY sleepy.

Q: My daughter woke up with rash on her face, which is also kind of puffy. That is her only symptom, no aches, fever, swollen glands, or anything else. What do you think this is?

A: I have a rule — never diagnose a rash on the telephone (or by e-mail). If there’s no fever, and no other symptoms, it is probably viral. If anything else changes, she should be evaluated to be sure she is not contagious to others.

Q: I have a teenager (16) who has been on Lexapro 20mg for awhile. Recently he has been sleeping a lot and not eating. Should I be concerned?


A: Some teenagers DO sleep a lot. The real question is whether it is interfering with his daily life, school, friends, social etc. It could be a sign of worsening depression, which is probably why he is on the Lexapro in the first place. Appetite changes can also reflect that. You don’t mention his weight or height. Maybe he wants to be in “better shape” — just a guess. I think he should have a visit to his regular physician for an evaluation.

Q: We have an adopted 16-year-old African-American boy who has been diagnosed as having oppositional defiant disorder (ODD). Within the past two years his behavior has significantly turned hostile and negative (beginning at approximately age 14). He has been stealing, lying, refusing to go to school and obey home and school rules. Because of this out-of-control behavior, he is now in a boarding school. The question is, what are the symptoms of fetal alcohol syndrome (FAS)? This possibility has been suggested by his school counselor. Another teacher suggested that he be placed on medication for ADD (attention-deficit disorder). Neither of these conditions have previously been suggested by his doctor or psychologist, but the teachers and school saw him in action. We’ve tried everything but medication — new schools, psychological counseling, family therapy, and nothing worked. He is filled with anger and we are wondering what more we could have done.

A: First, your question seems to have a “guilt” piece — NOT FAIR! I am confident you have done as much as anyone could have. This is very complex. FAS definitely can present this way. There is a great FAS clinic at Children’s Hospital and you might want to call them. There is no “medication” for FAS, but there is much “overlap” with ADD, ODD, and other psychiatric disorders — including depression, which can also be a part of his frustration and behavior A very experienced psychiatrist (not a psychologist) would be a good resource. A trial on medication (Adderall or Ritalin etc.) would also be a possibility for partial treatment. They work quickly, so you would know in less than a week.

Try to find an experienced adolescent psychiatrist with expertise in this area. If you need a referral, call Children’s Hospital and ask for the Psychiatry Department (Division of Behavioral Sciences).

Q: Our 16-month-old daughter has had a “shiner” under her left eye for about a week and although it has faded, it’s still there and now has a bluish hue under her right eye. I am told this could be allergies, or ear infection, or virus. She is incredibly clingy, whiny, tired and irritable, so I’m guessing the dark circles under her eyes are from something other than just being tired.Edmonds

A: One-sided discoloration sounds more likely to be related to an injury, especially if it’s fading. Allergies would typically have lots of allergy symptoms, continued nasal discharge, sneezing, maybe increased tearing. Colds would be obvious, Ear infections probably wouldn’t present this way. Fatigue, maybe … Have her checked if you’re concerned about the fussiness.

Q: My 13-year-old son has had bowel problems for most of his childhood. His pediatrician diagnosed him as having encopresis and advised us to make sure he gets plenty of fiber. He’s since outgrown this problem but now has another problem. His bowel movements are often so large they are unable to be flushed down on their own. This first started happening when he was 11 and is getting to be more frequent. He says passing the movement is not painful, but I have a hard time believing that. He does have daily bowel movements and is of average height/weight for his age and eats a relatively balanced diet.
Federal Way

A: You didn’t say whether the stool is large in length or in width — a significant difference. If it is the width, it suggests a chronic dilatation of his lower colon related to his past history. If it is the length — that may be more related to diet, fiber and frequency of bowel movement which could be helped by a trial of Miralax (prescription). He would probably be helped by getting a Barium Enema — an X-ray dye test and/or seeing a competent pediatric gastroenterologist.

Q: I have three children, and my middle child seems to get into all sorts of trouble. What should I do to discourage this behavior, to tell him this isn’t the sort of attention he should seek?

A: In general, the more attention paid to inappropriate behavior, the more it will continue. Ignoring acting-out behavior (so that it doesn’t achieve its goal) should gradually decrease the frequency. Walking out of the room and briefly stating the reason should work eventually.

Q: How can you tell between a child having a hearing problem, and one who is just not listening? I have a 3-year-old, and I know he gets distracted easily, but after repeating myself numerous times to get him to acknowledge that I’ve said something, I’m beginning to wonder if he really can’t hear me. Should this be something I have checked out?

A: I’d consider having the hearing checked. At this age, it’s usually something a hearing specialist would do, rather than a pediatrician. If it’s checked and normal, you don’t have to worry about it anymore.

Q: My child has had a fever of 100.0 degrees for about three days, however, she is still active with her siblings. In addition to the fever, she has been vomiting phlegm every now and then. Should I take her in to see her doctor? Or is she just fighting off a bug?

A: The height of her fever is really not the issue — especially if it is under 101 degrees. But how does she feel? Is she still urinating despite the vomiting? Sounds more like a viral illness which will pass and not need a physician. If fever is over 101 for more than three days — see a physician.

Q: My 2-year-old won’t eat fruit or veggies. I have tried hiding them in foods, and he still won’t eat them. On his 2-year checkup he was 74th percentile on height and 90th percentile on his weight. His older brother has always been in the 99th percentile for height and eats all the good foods. Is this something he will grow out of? Should I be worried? His doctor told me to start giving him a daily vitamin, which is fine; I just worried about the long-term effect it might cause not having the fruit and vegetables.

A: On a daily vitamin, he is getting his basic nutritional needs, but the issue is “habit patterning.” If he learns he can have peanut butter and jelly or mac and cheese every day instead of fruits and vegetables, he will surely “go” for that. The approach should be: “This is what we are having for lunch or dinner. He doesn’t NEED to eat it, he just doesn’t get the other stuff instead. Don’t feel guilty that he will starve — he won’t. But remember that you cannot make him (obviously) eat the fruit or veggies.

Q: My son will be 6 months on Feb. 4. He already weighs 21 pounds (that was 3 weeks ago), and I’m very concerned. He eats two solid-food meals a day, rice cereal in the morning and usually a jar of veggies or fruit at night and three to four 8-ounce bottles during the day. Is that too much? Do I need to change his diet? Since he was born, he’s always had a big appetite.

A: Knowing his height would help provide a better answer as would knowing the results of a triceps skin-fold test (a pinch test on the upper arm to measure percentage of body fat). He is huge, but if his height is also on the 95th percentile that would make it less “problematic.” He should never have “fruit” because they have three times as many calories as vegetables and never cereal either (same reason). You might consider “diet” formula — using one scoop of formula to 3 ounces water instead of 2. But talk to your physician about that. There are potential issues of concern but more information is needed. Pursue this!

Q: Any advice or concern you have for a 4-year-old boy who refuses almost all fruits/vegetables? His tolerance is limited to raw carrots, apple slices, a few bites of banana or orange juice. His weight is average-low and he is otherwise healthy.
Mercer Island

A: Common question. I always recommend “dipping” veggies in anything — ketchup, mayo, soy sauce, cheese whiz, peanut butter. And providing several different dips arranged around the plate. Interestingly, despite what seem like poor diets in kids, most of them are healthy and do fine. If you’re really worried, vitamins are OK.

Q: We are Bainbridge Island residents currently living in Hong Kong since last August. Our almost 9-year-old daughter’s allergies (skin eczema, mild asthma, stuffiness) have really been bothering her lately, and I’m afraid it may be due to the severe pollution here. She says she feels tired most of the time. The latest development is that she has been having persistent infections of her fingernails for the last month, and now we are noticing that she has irritated or infected-looking eyes. We have had several visits to a family physician, and she has tried amoxicillin twice along with antibiotic ointment. The nails and fingers will get better and then suddenly get worse, regardless of whether she is picking at them or not. She also has a couple of small skin lesions (infections maybe?) around her nose. On our last visit, the doctor tested for yeast/fungus of the fingernails, but we are still waiting for those results (apparently it takes 2 weeks).

Any ideas? Does severe pollution and living in the sub-tropics sometimes suppress one’s immune system? We sure miss that clean Seattle air! Thanks for your help!

Hong Kong

A: I am impressed getting an e-mail all the way from Hong Kong. Anyway — subtropical living should NOT suppress the immune system but it can definitely change the way your skin and body reacts. The fingernail thing sounds potentially fungal and those tests DO take several weeks. The “infections” sound like she is colonized by a low level staph or strep infection which sometimes takes two to three months of low-dose, daily antibiotic to cure. The eye definitely sounds allergic in origin and can be helped by cold compresses or drops. I would personally consider: bathing daily with HIBICLENS (if they have that in Hong Kong) — it is an antibacterial soap; putting her on daily low dose Duricef or Keflex (an antibiotic); and using a low-dose steroid cream (Cortaid) on the red — but not infected — areas.

Good luck and come back soon.

Q: My daughter is 3 years old and still has cradle cap (flakey, scaly, dry scalp). What are the best remedies, and should we be concerned? It does not bother her.

Cradle cap is sometimes helped by using mineral oil massaged into the scalp about one half hour before washing the hair, then scrubbing the scalp fairly vigorously when washing. If that doesn’t help, consider an anti-dandruff shampoo, such as Selsun Blue.

Q: My 13-month-old daughter is constantly eating, yet she doesn’t grow. The only thing growing is her belly. She used to be in the 50th percentile for height and now is in the bottom 10th percentile. Should I be concerned? Her doctor doesn’t think I should be concerned.

A: Good question. In one regard, it depends on the genetics. If Mom and Dad are on 10th percentile, then baby WANTS to be on the 10th percentile and was just born “bigger” and is not “seeking a new curve” as we say. However, no matter WHAT percentile she is on, her WEIGHT should be approximately on the SAME percentile. So if her height is in 10th percentile and her weight is in the 50th percentile, the real issue may be weight and not height. This should be looked at a little more. There are ways to measure “BMI” (body mass index) — and triceps skin fold — the amount of fat vs. body mass. Ask your physician, again.

Q: My 6 month old is just getting over a bad case of chickenpox. He’s got eczema as well (poor kid!). My question is whether I can use vitamin E oil to help repair the skin and minimize scarring. Or is he too young?Seattle

A: Sorry he has chickenpox — that is unusual for someone of his age at this point in time with the vaccines available. But to answer your question: He is definitely NOT too young to use vitamin E oil to help the skin repair. There will NOT be any or much scarring as long as he doesn’t itch too much.

Q: My 2-year-old grandson has bright red cheeks and also a red area on an arm and leg. It started 2 weeks ago and comes and goes. No fever, no itch, no other symptoms. The 9-month-old started having bright red cheeks a few days ago. It comes and goes, but is not related to going outside or anything. They both have had throat and ear infections recently. What is causing redness and what should we do?

A: While a few diseases can actually cause what you are describing, it is very unusual for them to present on and off for two weeks, so it is more likely that he has “contact dermatitis” — meaning something in CONTACT with his skin is causing this. The contact can be things you cannot see — cold air, cling-free stuff in the dryer, new soaps, detergents, bubble bath. What you really need is a detective as opposed to a physician. However, in the absence of being able to figure it out, you can usually make the redness much less (if it is annoying the child) by using Cortaid — or other over-the-counter hydrocortisone preparations.

Q: My 3-year-old son is lactose intolerant and I am wondering if there is anything I can give him to help with the pain that he gets from having dairy. My doctor told me to keep him on a small amount of dairy to help keep the enzyme in his system, but he gets painful diarrhea from it sometimes and I feel so helpless. I was also told there is something I can put in regular milk to split the lactose up into digestible sugars, is this safe for the rest of my family and children, too?

A: First, you might at some point want to consider REALLY “proving” he is lactose intolerant. There is a simple test that can be done at Children’s Hospital called Lactose Breath Hydrogen Test — which will clearly diagnose the issue. However, to answer your question, you can buy LACTAID in any pharmacy — you add it to the milk, shake, leave for 24 hours and it makes the lactose “disappear.” Of course, you can buy lactose-free milk instead. The lactose-free stuff and/or the LACTAID are fine for everyone in the family.

Q: I have a 4-year-old son who is diagnosed with chronic asthma. He has asthma attacks typically when he gets an upper respiratory virus. He takes Singulair daily and is on Flovent twice a day, with albuterol as necessary. I am wondering with this preventive medicine on board if the RSV virus would still cause asthma attacks or not.
Location unknown

A: He is being well-treated — compliments to you and your physician. NOTHING will prevent him from getting RSV, unfortunately, and it will NOT prevent him from having that trigger an asthma attack. But his current medication should make it much less severe or intense, so definitely keep him on that regimen. Also, the younger you are, the worse the RSV tends to be, and while 4 is “young” it is sort of “old” for severe RSV.

Q: My son has had bad breath since he was an infant. At that time there was no stomach disorder or sinus infection. It has persisted continuously; he is now 8 years old. Any thoughts on why or management? He also has an incredible level of flatus, regardless of diet, which is becoming a problem because his friends make fun of him. Again, any thoughts on management? He sees the dentist and orthodontist regularly — they have had no suggestions. He sees the pediatrician for well-child visits yearly, and as needed.

This is a pretty common question. Over the years, it has been frustrating because there is really no specific reason to explain bad breath after you’ve eliminated dental, sinus and tonsil problems. Possibly some digestive problem which could also account for the flatus, but you’d have to watch carefully and document food intake and symptoms. Frequent brushing and breath mints are helpful.

Q: We recently had a baby and have received conflicting advice about establishing some sort of sleep routine for the infant. When is the best time to start this? Our baby is not sleeping more than 2 to 3 hours at a time. Is that normal?

A: You don’t say how recently you had the baby so I don’t know her/his age but my personal opinion is that it is NEVER too early to establish a routine … not that the baby will “stick to it” right away. But what you are establishing is “habit patterns.” My favorite expression is “never pick a fight you cannot win” — you cannot make him SLEEP but you CAN make him wake up. So, he should never sleep longer in the day at any one stretch than he sleeps the night before. Wake him up! When finally, at the end of the day, you don’t wake him he will be so exhausted that he will hopefully sleep longer that night. By two weeks of age, he should be sleeping LONGER at night than during the day, and by six weeks, he should be sleeping six hours AT A STRETCH. There is an excellent book by Joanne Cuthbertson called “Helping Your Child Sleep Through the Night” — you might check it out of the library.

Q: What tests can differentially diagnose between ADHD and Tourette Syndrome in a 9-year-old boy? I’ve heard that starting a child on a stimulant to control ADHD symptoms can irreversibly trigger Tourette Syndrome. The child is high-functioning autistic with family history of obsessive-compulsive disorder and pervasive developmental disorders, but no known Tourette history.
Walla Walla

A: ADHD and Tourette Syndrome are fairly distinctive. There aren’t any “tests” to use to diagnose either. Mostly it’s looking at the history and behavioral features. Usually with ADHD there aren’t any abnormal movements or vocalizations. Some of the ADHD medicines can lead to tics, but, in my understanding of the data, it is generally reversible when the meds are stopped.

Q: My 3-1/2 year old daughter seems to have frequent (3 times) per week nightmares/night terrors. She wakes up screaming and isn’t really awake. It seems to take about 5 minutes to wake her up, then she doesn’t remember anything. Is this normal? What can I do to help her?Spokane

A: This is a very real and very common and “normal” problem at this age. She is NOT just “wanting Mom” — otherwise she would be fully awake and excited to see you. We call them “night terrors.” They are OFTEN related to visual input (TV as an example) and that doesn’t mean watching murder and mayhem, necessarily. Sesame Street can be a terrifying visual input to a 3 year old. My own daughter was totally hysterical because Big Bird fell and hurt his nose — she had night terrors for months based on that input. While you don’t want to make it a punishment, you might try eliminating TV for a week — including videos, etc. When she does have the events you need to comfort her as you are and TRY to explore the subject matter.

GOOD LUCK — this is a TOUGH ONE!

A: My 2-1/2 year old has had mild diarrhea for the past week. On a couple of days last week he had one to two diapers full, then he would be fine for a day, then a day with one bad diaper, etc. Yesterday he had two diapers full again. He has no temperature and is acting as happy and active as ever. I can’t think of any dietary changes we’ve made. What should we do? Or is it ‘normal’?

A: Diarrhea is almost always due to viral causes. It’s not unusual for it to last one to two weeks after it starts. These days, we’re not recommending any major changes in diet, except for maybe avoiding greasy foods. Any food he’s interested in should be OK. If it lasts longer than two weeks or so, or he seems sicker, he should get checked.

Q: A family member is addicted to very high levels of Oxycontin. She says she takes 180-200 mg a day, and has been using it for 8 months. She is breastfeeding a 12-month-old baby. What is the risk to the baby?

A: Wow! I have several issues here. The most important is the mom’s competence with that high a level of Oxycontin in her system. Sometimes people on that level don’t make the best decisions. As for the breastfeeding, I am VERY worried about the baby. Some of that will cross through the breast milk, although in small quantities, but she is on such a HUGE dose it can definitely make the baby “groggy” and potentially affect brain development. This is a “borderline” case for CPS (Child Protective Services). Thanks for your concern!!!!

Q: My 21-month-old grandson puts everything in his mouth. We have seen him pick up cat hair, pull fuzz off a wool sweater or a polar fleece jacket, put it in his mouth and if we don’t get there quick enough, he swallows it. He is not a big eater and this habit does not seem to be related to being hungry. Other than this, he is a happy, healthy child. Is this dangerous, and what should we do about it? Could he have some kind of vitamin deficiency?Kent

A: This is not too uncommon. It’s probably not due to any vitamin or mineral deficiency, but more likely a habit. Suggestions: Try to keep objects away that you don’t want him to chew on. If it’s safe enough to chew, try to ignore it, as attention will sometimes cause it to continue. Most kids outgrow this by 3 to 4 years old.

Q: At our 15-month-old’s check-up, a pediatrician (not our regular one) thought she detected a heart murmur in our daughter. We plan to follow up w/ regular pediatrician at 18 months, but of course now this is on my mind! This most recent pediatrician said child may grow out of it — what information can you provide on this subject, please? Thank you.

A: Heart murmurs in young babies are VERY common and 99 percent of them are of NO significance. They are called “flow” murmurs … just the noise of the blood going through the heart. If the baby is growing, eating, thriving, developing, happy, etc., I would not lose one minute of sleep on this subject. It most likely will go away and if it doesn’t, it most likely will not matter.