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News from Baby Medical Q&A, Issue #025
October 01, 2008

New Questions and Answers

Question: My daughter is 2 and a half and within the past month or so has had loose stools on and off. This past week it has turned into diarrhea with no other symptoms. She acts completly fine. After reading your site I think this may be the toddler diarrhea (thankfully).

The one thing that worries me is that when we wipe her vaginal area she says it hurts and pulls back from us. This started right around the time the loose stools began. She does not complain when she pees only when she is wiped. I have read to give her a bath with baking soda, do you have any other suggestions so I do not have to take her in to the doctor and be most likely put on an anitbiotic (which I am trying to avoid) thank you in advance for any suggestions that you may have.

Answer: Little girls do not have the same hormones as women and as such are prone to dryness in the genital area which means that area is more easily irritated and inflamed. We call this vulvovaginitis and I suspect that is what your daughter has - the diarrhea may have just aggravated things. I would expect that the genital area looks a little red and inflamed.

The treatment of vulvovaginits is to avoid irritants - so no bubble baths, don't use soap, just wash with warm water. Use white unscented toilet paper, and cotton underwear.

Try a probiotic or give your daughter live yoghurt to eat to get the normal environment back in the vagina. Antibiotics are not likely to be of any benefit.

A soothing baby cream for the diaper area may make your daughter more comfortable as things settle down by themselves.


Question: My 7 year old step-son has gained 30 to 40 pounds in one year. He never seems to get full. We have cut back as far as snacks but he begs for food all the time. We have changed his doctors and we will see what the new one thinks. His old doctor said not to worry because he don't have folds. If you have any feedback it would be greatly appreciated. We are just worried it may be medical.

Answer: It is unlikely your step-son has a medical problem. See growth charts to check your stepson's weight for height. If the height is less than the 10th centile but the weight is over the 90th centile, see your doctor again.

Also see guidelines on healthy food.

If your stepson begs for food, give healthy options, like a piece of fruit - if he is really hungry, he will eat that. Give water for drinks and avoid carbonated drinks.

Eat at the table as a family and don't let your stepson eat in front of the television or computer.

Hopefully these tips will help.


Question: My 1 week old grandson has a fluid pocket on the top side of his head is this common it is not a soft spot it is about the size of a golf ball or bigger should we be concerned?

Answer: It sounds as if your grandson has a cephalhematoma which is a bruise due to the birthing process. It starts off hard but then feels soft in the middle. These can take several weeks to completely disappear.


Question: My baby smells like copper, like the smell of your hands after you count change. Do I need to see the doctor?

Answer: I can't think of any disorder that makes babies smell like copper. There are many metabolic disorders that can cause strange smells and a blood test at birth (Guthrie) will often detect them - ask your doctor if your baby had metabolic tests with the Guthrie test.

If there are other concerns such as poor weight gain or developmental concerns, a urine test can be done looking for metabolic disorders.


News and Updates

Treating Fever in Children
There has been quite a bit about antipyretic agents (those that control fever) in the medical press lately and it is important for parents to know what the latest research means for your child when he or she has a fever.

There has been a study that has shown that combining paracetamol (or acetaminophen as it is known in North America) and ibuprofen is more effective at treating fever but there is no evidence on whether symptoms are also reduced more effectively with both drugs used together. No drug is completely without side effects and so the current advice remains that one or other of Paracetamol (Acetaminophen in North America) or Ibuprofen is used first alone, with the option of adding the other in if no response.

My approach is to advise Paracetamol (or Acetaminophen in North America) as first line because overall Ibuprofen, even though it has a good safety profile in children, is more likely to produce side effects than Paracetamol (Acetaminophen).

There has also been another study that shows an association with paracetamol use and asthma in children. This does not mean that paracetamol (acetaminophen in North America) use causes asthma, however there should be caution in using excessive amounts of paracetamol (acetaminophen), and it should only be used when necessary. Treating a temperature just because it's there is not necessary - only treat if your child is miserable with a fever.

My advice for treating fever in children is this:

  • only treat if your child is miserable with the fever - don't treat a fever just because it's there
  • only treat if the temperature is 38.5 C (101.3 F) or above
  • use Paracetamol (Acetaminophen in North America) as the first option, and only add in Ibuprofen is there is no response
  • do not use Ibuprofen in chicken-pox
  • use drugs in the appropriate doses - see below
  • store medications, especially Paracetamol (Acetaminophen) safely

References

  • Richard Beasley, Tadd Clayton, Julian Crane, Erika von Mutius, Christopher K W Lai, Stephen Montefort, Alistair Stewart, for the ISAAC Phase Three Study Group. Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6–7 years: analysis from Phase Three of the ISAAC programme. Lancet 2008; 372:1039-48
  • Alastair D Hay, Céire Costelloe, Niamh M Redmond, Alan A Montgomery, Margaret Fletcher, Sandra Hollinghurst, Tim J Peters. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial. BMJ 2008;337:a1302
  • National Institute for Health and Clinical Excellence(NICE). Feverish illness in children. Assessment and initial management in children younger than 5 years. 2007. www.nice.org.uk/CG47

Have you seen this website?

A to Z Baby Guide - a parents guide to parenthood. This new site has a great baby name resource, including a comprehensive list of Maori baby names.


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