Q:  I am frustrated right now because my child who is will be 4 in a few months has been potty trained since the early part of 3. She had a few accidents during the night but only occasionally. Lately she has gone through this phase that it is practically every night and we have since gone out and bought pull ups so that we can sleep through the night and so can she. It doesn't seem to bother her at all. I have asked several people including the doctor and they said it usually happens when something tragic happens in their life. Really, nothing has happened in her life. We have a good family life, her father and I have a good relationship and our routine rarely changes. I don't know where to go from here. We have tried rewarding her with smiley faces, which she loves but after a while that the excitement wore off when she started to wet the bed too often. Any advice?

A:  Relapses in potty training is not uncommon at all.  Try limiting fluids a couple of hours before bedtime.  Of course, be sure she is getting enough fluids earlier in the day.  If the diaper at night helps everybody get a little more sleep, I don't see anything wrong with it.  Give her a little time, try not to make too big a deal out of it with her so she doesn't feel she is doing something wrong or on the other hand getting too much positive attention.  If the problem doesn't right itself in the next few months, you
could bring up the subject again with the pediatrician.

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  Rash (Augmentin)

Q:  I took my 19 month old to the doctor today and she gave him augmenten es for an ear infection.  Tonight while changing to pajamas we noticed several little spots all over him.  He had the chicken pox vaccine, but they look like pox.  Will the medicine interfere with this?  Also I have a 3 month old, is she at risk for getting them?

A:  The rash could possibly be a reaction to the Augmentin.  Call your doctor to report this.  Be sure the reaction is noted in your child's record for future consideration before giving medicines in the penicillin family.

A:  It sounds like your gastroenterologist friend is thinking along the same lines I am.  I would definitely get this checked out further by a specialist.  Perhaps you can ask your pediatrician to recommend a gastroenterologist who specializes in children. This problem is very concerning and should not be taken lightly.  Thanks for asking and good luck.  Nurse Nana

A:  It seems that the routine for your baby prescribed by your pediatrician is to help with a condition called "reflux" This is where the tummy contents splash back up into the foodpipe causing the baby to spit up frequently or have some discomfort. All of the hints your Dr.  gave you are the right things to do for this condition. Many babies have this and eventually outgrow it. It can be quite annoying for parents to constantly have to clean up the spit-up but usually it is not a concern unless your baby is losing weight or unusually fussy. There are several medications available that are quite helpful but,of course,  you would need to discuss that with your Dr. Also try giving your baby smaller feedings more frequently. This keeps his tummy from being quite so full.

In answer to your question about the hernia...a baby can have vomiting with a hernia if the hernia is causing  problems. You would know that by the fact your baby probably would be very fussy, seem to be in pain, running a fever or acting sick. If he has any of these symptoms, you should have him checked by a pediatric surgeon.  Thanks for asking.  Nurse Nana

  Cradle Cap

Q:  Hello. I have a concern that my 7 month old daughter may have cradle cap, her scalp is very dry, flaky and even scaly. I have used head and shoulders shampoo and looked in my medical reference books, but can not find further info. on how to treat this. Any suggestions?   Thank you for your time.

A:  Hi! Cradle cap is a seborrheic dermatitis.  The cause is not known but it is common in infancy when sebum production is increased.  There are thick, adherent, yellowish, scaly patches on the scalp.  The scalp should be cleansed with a mild shampoo like baby shampoo.  You can soap the baby's scalp and let it soak while she is playing in the tub.  Then scrub gently with a bath cloth or soft brush. (Do hospitals still give those soft plastic brushes to newborns? That would be good to use.)

If this doesn't sound like what your child has, consult your pediatrician and don't use harsh shampoos, etc., without your physician's orders.

  Teething

Q:  My little boy is 2 years old and has recently been suffering from febrile convulsions.  He has had 3 in the last month.  I have been told that this was due to a viral infection by the hospital.   Could it also be brought on by his back teeth coming through as the first attack happened on 13 Feb and the second came on last weekend. 

I know that children can suffer for a while when their back teeth are coming through but can you give an rough guide on how long it takes back teeth to come through the gum.

A:  There is really no way to tell how long it will take for back teeth to come through the gums.  The gums will be red and swollen and it can go on for quite some time before the teeth actually come through.  You can ease the discomfort by giving him a cooled teething ring but at this age, he will
probably not use it and it is hard to reach the back tooth area anyway.  You might have better luck with the topical ointments that numb the area.  They are available without a prescription.

I do not think the teething has anything to do with the febrile seizures. Most sources say teething does not cause fever but many parents (including me) have observed a low grade temp with teething.  However, a high grade temperature would indicate illness.

  Nose Bleeds

Q:  What causes nose bleeding? I am a Grandmother and I suffered from nose bleeding as a child. My son and daughter also suffered from nose bleeds, and no my granddaughter who is 3 and a twin. Her sister does not suffer. Is nose bleeding inherited from generation to generation? What are some  good techniques to stop the bleeding?

A:  I do not know if the tendency to bleed from the nose is inherited or not--seems possible.  The nose is very vascular and bleeds easily, especially after trauma (blows to the nose, nose-picking, foreign bodies) and with allergic rhinitis or upper respiratory infections which irritate the mucosal lining of the nose.

To stop the bleeding, have the child sit quietly and lean forward to prevent aspiration of the blood. Apply light pressure to the lower part of the nose with a thumb and forefinger.  If the bleeding persists, insert cotton or wadded tissue in the nostrils and apply a cold cloth to the bridge of the nose.  After the bleeding stops, a light coating of petroleum jelly (like Vaseline) may be applied to the inside of the nostrils to prevent dried blood from crusting and tempting the child to pick it and cause the bleeding to begin again.

Nosebleeds are generally not anything to worry about but if they persist, a physician should be consulted to rule out the possibility of bleeding abnormalities.  Aspirin has been indicated as a cause of nosebleeds, even when taken in normal amounts.

  Constipation

Q:  I have a grandbaby that is having trouble going to the bathroom. She seems like she strains a lot. She is 2 weeks old. what should we do?

A:  If the baby is just turning red and straining, that is normal for a newborn.  If the stool is too firm, that could be from not enough water in the formula mix.  Be sure to mix it up according to directions.  Breast-fed babies do not usually get constipated.

  Rash (Chicken Pox)

Q:  my 2 year old daughter has developed tiny bumps all over her body that keep spreading. Now she is always itching.  The nurse at Kaiser originally said it looked like the chicken pox but when the other nurse practitioner looked at her, she said it was not and was not sure what it was. The wrote is was a rash and non contagious. Possibly an allergic reaction to Claritin. The bumps keep coming, now on her face. Should I go and see another doctor? Please advise.

A:  It is impossible to determine what kind of rash your little one has without seeing it.  There are of course many viruses going around and medication reactions are always a possibility. And sometimes rashes come and go so quickly that the real reason is never known.  But you should not stop trying to find out what it is as long as she has it. If you are not getting any results at your regular Dr's office, find a dermatologist in your area. It's important to find out if it's contagious to protect other children your daughter may be around.   Thanks for asking.  Nurse Nana.

Q:  "Dear Nurse Nana - I am a high school student.  My psychology class is doing "flour babies" - we carry around 10 lb sacks of flour like they are infants.  how often should I be feeding my "baby", and how much, and how often should I be changing his "diaper"?"

A:  If your baby is less than two months old, he or she needs to be fed every 2 to 3 hours!!!  The diaper probably needs to be changed about that often as well.  Your questions really cannot be answered fully unless I know the age of the baby, but maybe this will help.  Feel free to email me back with more detail if you wish.

  Whole Milk vs. Skim

Q:  Is whole milk better for our children than skim milk,  or worse? I have heard two different stories. Also, it is true that milk promotes mucus in our throats and can cause sinus infections?

A:  It is generally accepted that skim or low fat milk should not be substituted for whole milk for children because skim milk does not have enough fatty acids and the concentration of proteins and electrolytes is too high.  As far as the mucus and sinus problems, I have heard about this possibility
but I do not know if there is any scientific proof of this.

  Overweight Kids...

Q:  A friend has a daughter that is 10 1/2 years old....160 pounds...about 5 ft.  She has been on thyroid medication for almost 2 years now with no significant decrease in her weight. However, she has gained 20 pounds in a little over a year.  My friend is exasperated about what he feels is a misdiagnosis, non-therapeutic dose of medicine for his daughter. I think the major problem is not her thyroid, but a major overeating problem along with non-activity. How can you determine a true thyroid problem? Should he take her for a second opinion?

A:  A second opinion is never a bad idea.  If the child has a problem with her thyroid gland, a physician should be able to tell by some lab tests and by the symptoms.  If your friend is unhappy about his child's diagnosis, it would certainly be advisable to talk to the child's doctor about his
concerns and possibly to get a second opinion.

See also:  this FAQ

  Breastfeeding & Pumping

Q:  Dear Nana, my baby girl is 5 months now and she is exclusively breastfed.  I plan to work soon but have the following problem:
1.    she won't take teats (no pacifiers, bottles).  how can she be fed?
2.    do I need to sterilized the pump equipments (incl the bottle) which I bring to work?
3.    how often should I pump during the day at office (duration of pump and how many hours apart)?
4.    how old then can she be taking solid food thru out the day and no milk needed?

A:  If your daughter will not take bottles of any kind, you may want to try a cup.  There are brands available (I recommend Avent, which comes with a special "spout" to make it easier for very young babies) specifically designed to transition from breast to cup.  Obviously, she will not be able to hold it herself right now, but her caregiver can easily help her drink from it.

You probably just need to wash the pump equipment and bottles in soapy hot water after using them.  You might want to check your owner's manual or with the company who made your breast pump, however.

Your baby will continue to need breast milk throughout the day until she is a year old.  Although you are gradually introducing solid food, she still needs breast milk with or after her meals and throughout the day as needed.

Ideally, you should pump at work at the times your baby normally breastfeeds.  This way you can keep your milk supply flowing adequately. There is no set amount of time to pump; just pump until the milk seems to "run out".

For more details on working away from home and pumping, consult What to Expect the First Year.

  Overweight Kids...

Q:  I have a granddaughter that is 4ft.11, and weighs 115lbs.  I think that is too much.  How can I talk to her about calories without making her a eating problem?

A:  Your granddaughter's weight and height don't seem too unbalanced.  I don't know how old the child is but it is always good to teach children good eating habits and about healthy foods in a fun way.

If there is concern, perhaps her pediatrician or family doctor could be consulted. 

See also:  the following FAQ below...

  Vegetables and Junk Food

Q:  My daughter is 7 years old her weight is 30 kilograms I am afraid she is overweight. Can you advice me? shall I put her on diet? but what kind of diet? Guide me please.

A:  Whether or not your child is overweight would depend on her height.  If you are concerned, speak to her pediatrician or family doctor to find out if she is overweight for her height.  All children should eat a healthy diet such as the one recommended by almost all nutrition experts now, the food pyramid.  If you are unfamiliar with this concept, it focuses on eating enough fruits, vegetables, and whole grains with fewer sugars and fats and a moderate amount of protein foods.

See also:  the following FAQ below...

(NOTE:  30 Kilograms is approx. 66 lbs.  Source:  Convert-Me)

Q:  I have a 9 year old son who is about 4'10" and weighs 135 pounds.  We kept hoping it was a stage and he would get taller and thin down, but for the last 2 years or so it seems to slowly be getting worse.  He is at an age now where he is conscious of it, kids tease him, and we have made it out
our New Year's resolution to get some of this weight off him and get him in shape.  He is taking karate for an hour a week and tennis for 2 hours and we got him a trampoline for Christmas and he jumps most days.  He seems very hungry with the smaller portions and I have trouble saying no when I
believe that he really isn't satisfied.  He only eats a few vegetables, but we have really changed our eating habits, especially dinner.  Are there any special things I should know about limiting a child's caloric intake and any special things that seem to work better for them?

A:  As always, I recommend talking with your child's pediatrician or family doctor.  He or she could probably recommend some literature that would help you with diet planning.  The food pyramid is helpful--you could probably get information on this at your local health department, but it basically
recommends more fruits and vegetables and whole grains and fewer sugars and fats with a moderate amount of protein foods.  Changing a child's diet is always tricky, especially with picky eaters but learning good eating habits will be of lifetime benefit.

Q:  My son, age 10, seems very depressed, doesn't smile a lot or show a lot of interest in anything besides watching TV or playing video games. We have taken him to doctors, and have received various
diagnosis...from low self esteem, dyslexia, to ADHD.  He has been on several different medications, (including Prozac) each with its own side effect. Currently he is on a new med for ADHD, which seems to help him focus but he is not himself, personality wise. He complains of being tired all the time. I am at my wits end..This is not the life of a normal 10 year, and I want to see him healthy and happy. Do you have any advice?

A:  Many children go through periods of depression, usually brought on by upsetting events in their lives.  However, these periods don't usually last very long.  From the sound of your letter, this has been going on for some time with your child.  Feeling tired all the time is a symptom of depression but it could also be caused by the medications.  This is a problem that you should discuss with the child's physician.  If you don't get the help you need, get another opinion.  Thanks for asking.  Please let us know how he is doing.  Nurse Nana

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