Ask A Doctor - Pediatrics

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Q.
Can preventive measures be taken against SIDS?
A.
There are many things a parent can do to reduce their baby’s risk of SIDS (Sudden Infant Death Syndrome), the leading cause of death in infants age 1 month to 12 months in the United States. First of all, quit smoking if you plan to become pregnant. Smoking during pregnancy and after your child is born increases the risk of SIDS. Go to the doctor regularly during your pregancy for routine prenatal care. Once the baby is born, he or she should never share a bed. The safest place for the infant to sleep during the first months is in a crib with a firm mattress in the parent’s room. All soft objects and loose blankets should be kept out of the crib. Babies should always be put to sleep on their backs (never on the stomach or side). In order to avoid overheating, the baby should be lightly clothed, and not be near a radiator or direct sunshine. Also, using a pacifier once breastfeeding is fully established may reduce the risk of SIDS.

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Q.
My 13-year old daughter was diagnosed with a severe case of herpes infection a couple of years ago, with fever, and sores in the mouth and throat which lasted for several weeks. She occasionally gets cold sores in her lips now. Is there any thing we can do to prevent another severe outbreak?
A.
The major symptom of herpes simplex infection is the outbreak of painful blisters on a red base, often around the lips area, which rupture to form ulcerative scabs lasting for few days to few weeks. The first episode of herpes infection is usually worse, and can be accompanied by fever, headache, and tender, enlarged lymph nodes. Further outbreaks and recurrences tend to be milder, shorter in duration, and can be triggered by stress, a cold, fever, fatigue, sunburn and local trauma to the skin.
Herpes can be treated but not cured. Avoiding triggering factors such as sunburn and stress can help prevent additional outbreaks. Lysine supplements and zinc may be beneficial in preventing recurrences, but no unbiased clinical evidence exists to support this. Therapy to suppress herpes with the daily oral antiviral medication Acyclovir is considered for patients with very frequent (more than 2 outbreaks in 4 months) and/or particularly symptomatic recurrences. Daily oral Acyclovir therapy, however, may contribute to the risk of developing resistance to the drug, so re-evaluation is needed after one year to decide if longer suppressive therapy is needed.

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Q.
I am having problems potty training my 2 year old. Should I be concerned? What is a good age to begin?
A.
Most two year olds are still in diapers. In my experience the average age for a child’s first success at toileting is 27 months and being trained 2 1⁄2 years of age. However, 15% of healthy, normal three year olds are not completely potty trained. That group probably includes future rocket scientists and other successful people. Bowel control is usually achieved earlier than bladder control, except in the case of a child with chronic constipation. When a child demonstrates a body awareness with respect to toileting, and is willing to sit on the potty/toilet to void or stool, then he is ready to establish a behavioral pattern of normal toileting. It is not unusual for a child to show some initial interest at an early age, much to the great satisfaction of parents, only to relapse and become resistant to using the potty. At this time parents should simply back off. At three, kids are usually amenable to some reward system, although parents should not make too much of a big deal about what is a normal, expected function. The number one reason for a child to be resistant to efforts to potty train is chronic constipation with the association of pain and discomfort with a normal bodily function. This latter issue can be discussed with your child’s physician.

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Q.
I just brought my baby home from the hospital. When should she have her first visit with her pediatrician? What should we expect on the first visit?
A.
The first baby visit after your newborn is discharged from the hospital will be between 1 and 7 days. If your baby had a very short time in the hospital (less than two days), or if she has any symptoms such as poor feeding or jaundice (yellowness), the Pediatrician will want to see her fairly soon, in a day or two to check the weight, baby’s color and activity level. If your baby was discharged after 2 days or more in the hospital and is perfectly healthy and normal with no symptoms the Doctor may choose anytime for the first exam, most likely from 3 to 7 days after discharge. The exam may be just a quick weight, color and activity check but sometime within the first week or so the doctor will do a complete exam of your baby. Two exams were already done in the hospital. The exam will include using an instrument to check the eyes, a stethoscope to check heart and lungs, and a complete body exam. The doctor will also listen to your questions and have feeding or other advice for you. In any case if, during the first two months of life, your baby has a fever, or is cold and clammy, or becomes jaundiced (yellow), or has breathing difficulties, call the doctor right away. Be sure to have baby sleep flat on his or her back since this decreases the risk of SIDS (sudden infant death syndrome).

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Q.
We are expecting a son in a few months. What are the pros and cons of having him circumcised?
A.
Circumcision is the surgical removal of the foreskin from the penis. It appears to have some medical benefits, but also carries potential risks. Despite the benefits and risks, circumcision is neither essential nor detrimental to the boy’s health. The American Academy of Pediatrics does not find sufficient evidence to medically recommend circumcision or argue against it. Circumcised infants are less likely to develop urinary tract infections, and have less penile problems such as irritation and inflammation. The benefit may even go beyond infancy to adulthood. Neonatal circumcision confers some protection from penile cancer. Circumcised males may also be at lower risk for sexually transmitted diseases, including HIV. Complications of newborn circumcision occur in between 0.2% to 3% of cases. Of these, the most frequent are minor bleeding and local infection. Other less common complications include meatal narrowing, fistula formation, etc. There is also considerable evidence that newborns who are circumcised without local pain killer experience pain and psychological stress. It is therefore recommended that pain relief measures be used if their baby is to be circumcised.

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Q.
What is dysgraphia and how is a child tested for this disorder?
A.
Learning disorders affect 3 – 10% of school age children. Dysgraphia is a disorder of written expression. It may not be diagnosed until later grades when schoolwork demands larger amounts of well organized written work. Several subtypes of dysgraphia exist. A child with this disorder may have problems visualizing the shapes of letters or words. His handwriting may be poorly legible with inconsistent spacing between words. Another child may have grapho-motor memory problems with difficulty recalling letter and number forms rapidly and accurately. That child may spend a lot of time on individual letters and prefer printing to cursive writing. Another example would be a child who has trouble localizing his fingers and specific hand muscle groups while writing. He may need to keep his eyes very close to the paper and apply excessive pressure to his pencil. Learning difficulties benefit from a multidisciplinary evaluation with input from the primary pediatrician and a pediatric developmental specialist and/or a psycho-educational specialist to analyze the child’s academic skill set. A child also has a guaranteed right for a school evaluation as per U.S. Public Law 101-476 and IDEA (Individual with Disabilities Education Act). If a problem is diagnosed, under section 504 of the Rehabilitation Act of 1973, the child may qualify for educational accommodations. Examples of such accommodations could include using a word processor versus writing, or giving oral versus written reports. Occupational therapy may also be helpful.

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