Medicine Mondays: Circumcision; Discipline and Young Children; Vitamins and Children; Bug Spray and West Nile Virus
Posted Sep 07 2008 8:39pm
Welcome back to Medicine Mondays where each Monday I post the answers to questions that I have collected over the week. If you have a question please feel free to send me an email or leave me a comment. I welcome every comment and hope to help answer some questions. Just remember that my advice is not a substitute for a physical exam and the medical advice that your family doctor can provide.
Question: My 2 year old son had a circumcision at birth, it seems as though it were incomplete, his foreskin is mostly still intact, although “loose” I still have to retract and clean underneath, he absolutely hates it. With that being said, my middle son’s circ. was complete and perfect. I’ve had this on my mind since his birth, he had several resistant ear infections, so placing ear tubes at 9 months took priority. So, all along both of my pediatricians have said the same things, wait, it will get better, it would only be cosmetic, the risk outweighs the benefits– infection, sedation… So, what to do? My husband wants the extra foreskin removed, in my heart, I do, too , he will look “like” his brother, but medically speaking, it’s not necessary. Why now? Well, I don’t want to wait any longer, he’s already 2, potty training… and the 2 older ones are in school. My close friends say, do it, even my medical friends, they’ve had close friends who have regretted not doing it. Let me know what you think!
Answer: You're right, a circumcision or revision of a circumcision is not medically necessary. If you ask a hundred people you may get a hundred different opinions but really the best answer is what your family wants to do. There are plenty of people who still circumcise their child and a growing number of people who do not. What is boils down to is what you're comfortable. Make a decision that feels right for you and then discuss it with a pediatric urologist. They will be able to guide to as to what time is best for your son if you do decide to revise the procedure.
Discipline and Young Children
Question: How should I discipline my 15 month old as far as hitting other kids at school is concerned? Was told she had some alone time today because he hid another toddler and pulled her off a toy outside, (of course it is the teachers kid!) She has an older brother that is a bit pushy and I think she is projecting on other kids.
Answer: A 15 month old is too little to exhibit a lot of self control but this doesn't mean that it's okay! At this age if they get upset they can hit or bite to get their way. It becomes particularly effective if they then get what they want following the incident. I have found that saying firmly, "We don't hit our friends!" and then having the child say their sorry or offer a hug is the best response. Don't expect your child to be perfect and remember that it does get better! Time outs can be effective but make sure that it's no longer than one minute for each year of their age.
Vitamins and Children
Question: A friend’s child just had her 2 year check up at Kaiser and had blood work done showing her child’s iron levels were low. She was told to begin giving her daughter a children's vitamin with iron. However, my son didn’t have this blood work done when he had his 2 year appointment at your old office. What is your opinion on vitamin supplements for toddlers? My son is a pretty good eater, though he’s not a big fan of meat. I can usually get a veggie or two in him, but his favorites are fruit, yogurt, and oatmeal.
Answer: Each pediatric office does their screening a little different. At my previous office we screened at 9 months of age. If the hemoglobin was low then we placed children on an iron rich diet or iron drops and then rechecked in a few months. The next routine screening was at 4 years of age- sooner if they were shown to have a problem. I haven't routinely recommended vitamins for a child unless it was clear that their diet was lacking. If a parent is concerned then just a plain chewable multivitamin is fine- liquid if they are under 3 years of age. Your dentist can also determine if your city has fluoridated water and whether you need a fluoride supplement.
Bug Spray and West Nile Virus
Question: A case of West Nile Virus was found in a dead bird in our neighborhood. What are symptoms of West Nile Virus? Should bug spray be used on kids anytime they go outside?
Answer: The Center for Disease Control and Prevention has a West Nile Virus Home Page that can guide you in whether your city is at risk for contracting the disease.
The CDC reports that The Symptoms of West Nile Virus are:
Serious Symptoms in a Few People. About one in 150 people infected with WNV will develop severe illness. The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.
Milder Symptoms in Some People. Up to 20 percent of the people who become infected have symptoms such as fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days, though even healthy people have become sick for several weeks.
No Symptoms in Most People. Approximately 80 percent of people (about 4 out of 5) who are infected with WNV will not show any symptoms at all.
The best defense is to apply mosquito repellent to protect your child against being bit.
EPA recommends the following precautions when using insect repellents:
Apply repellents only to exposed skin and/or clothing (as directed on the product label.) Do not use repellents under clothing.
Never use repellents over cuts, wounds or irritated skin.
Do not apply to eyes or mouth, and apply sparingly around ears. When using sprays, do not spray directly on face—spray on hands first and then apply to face.
Do not allow children to handle the product. When using on children, apply to your own hands first and then put it on the child. You may not want to apply to children’s hands.
Use just enough repellent to cover exposed skin and/or clothing. Heavy application and saturation are generally unnecessary for effectiveness. If biting insects do not respond to a thin film of repellent, then apply a bit more.
After returning indoors, wash treated skin with soap and water or bathe. This is particularly important when repellents are used repeatedly in a day or on consecutive days. Also, wash treated clothing before wearing it again. (This precaution may vary with different repellents—check the product label.)
If you or your child get a rash or other bad reaction from an insect repellent, stop using the repellent, wash the repellent off with mild soap and water, and call a local poison control center for further guidance. If you go to a doctor because of the repellent, take the repellent with you to show the doctor.