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News from Baby Medical Q&A, Issue #008 -- May 2007
May 01, 2007

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The first question this month is about concern regarding speech development - a lot of parents have a similar concern - maybe the answer will be of help to you.

New Questions and Answers

Question: My son is 18 month old and he is not talking like other children of his age. What should I do to encourage him to talk?

Answer: The most important things when a child of 18 months doesn't speak are:

  • 1. does he hear? - children should respond to the telephone ringing or to being called by someone they can't see. If you are concerned about your son's hearing, see your doctor for formal tests.
  • 2. does he understand? If he understands simple commands, like "go and get your shoes", he is probably going to speak OK eventually
  • 3. is he interested in his surroundings? - eg. does he point to objects? If so, he probably doesn't have a communication disorder like autism
  • 4. can he make his needs known? - if so, then maybe he doesn't need to speak because he gets what he wants without doing so

If you answered Yes to the above questions, I wouldn't worry too much. Try and encourage him to use words to get what he wants rather than gestures. If he has older siblings, encourage them to wait until he asks for things rather than anticipating his needs.

If you can't answer Yes to all the above, see your doctor for a more formal assessment. Also see for more information on normal development at this age.

Question:How much water should a 3 month old be taking daily? Clear water. Not water in formula.

Answer: A 3 month old needs about 150 ml per kilogram per day (or 5 ounces per kilogram weight per day) of formula. An average 3 month old weighing 4.5 kg would need about 675 ml per day (or 22 - 23 ounces per day). This amount of formula will give enough fluid.

Additional water is only needed when it is hot and then it would be about 120-150 mls (or 4-5 ounces per day).

Question: My son is two and a half and swollowed two nickels almost a week ago. I took him into see his pediatrition and he said after doing xrays that there are two nickels that are still in his stomach and that we have to wait 6 weeks to see if he passes them on his own if not we will at that point do radiation treatments to get them out. Is this normal to allow money to stay in a todlers stomach for 6 weeks? is radiation really the way to fix it? will that hurt him? how do I know if it becomes a problem before 6 weeks?

Answer: If the nickels are not causing problems then it is usual to wait for them to pass naturally. Problems would probably be blockage so your son would have vomiting - that would mean there is a problem. I am not aware of radiation treatments to remove coins - usually they are removed via a small telescope. If your son needed that he would be anaethetised so he wouldn't feel a thing. See your doctor if your son develops vomiting.

Question: My 7 month old has extremely cold hands and feet. Sometimes they are almost purple in color. Should I be concerned about her circluation and call her pediatrician? Thank you

Answer: Some babies have poor circulation. Just keep her covered in the cold with gloves and warm socks. You don't need to see your pediatrician immediately unless your daughter also has blue lips or is unwell in any other way. Mention it when you next visit.

News and Updates

Immunizations - there is a recent study showing that a new high potency oral polio vaccine is more effective than the current oral vaccine used in India where polio is still a health issue. This is good news if polio is to be eradicated worldwide.

I am a big fan of immunization - I have seen children die of measles in Ethiopia where the children were not routinely immunized. And in the May Journal of Pediatrics, there is a reminder that 50 years ago, chickenpox (varicella) not uncommonly caused death.

I encourage parents to have their children immunized. The CDC have a useful booklet on immunizations for parents which you can download.

  • Grassly N, Wenger J, Durrani S, Bahl S, Deshpande J, Sutter R, Heymann D, Aylward RB. Protective efficacy of a monovalent oral type 1 poliovirus vaccine: a case-control study. The Lancet Volume 369, Issue 9570: Pages 1356-1362(21 April 2007-27 April 2007)
  • Blattner RJ, J Pediatr 1957, 50: 515-18

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