— Drina, Illinois Stretch marks, also known medically as striae, are remarkably common, even among teenagers: 70 percent of teenage girls and 40 percent of teenage boys develop them. They are caused by the stress of stretching skin, which releases substances that damage proteins in the skin, and are often seen during adolescents’ growth spurts, in women who are pregnant, and in overweight individuals. Stretch marks can also be caused either by steroid medications taken orally or by strong steroids used topically on the skin. Occasionally they are caused when the body makes abnormally large amounts of steroids, in a condition known as Cushing’s syndrome. Your children most likely have stretch marks because they are going through their growth spurts. Such stretch marks are most commonly seen on the outer thighs and the back and buttocks. They can also be seen on the breasts of girls and occasionally on the upper arms. Stretch marks are usually just a cosmetic problem and often fade with time. Topical medications like Retin-A have been shown to help improve stretch marks, especially if used early. Other treatment options include pulsed-dye laser and chemical peels. If you would like your children’s stretch marks evaluated further, I recommend that you take them to a dermatologist. Q2. What could cause a 4-year-old little girl to have underarm odor? She gets a bath every day. I thought it was just something she rubbed up against at first, but I’ve noticed the odor several different times now. Alicia, if the odor is mild and occurs only occasionally, it is probably nothing to worry about. However, if the odor is similar to adult underarm odor and is noticeable on a frequent basis (almost daily), or if you notice hair developing in her underarms, then it should be investigated further by her pediatrician and likely a pediatric doctor who specializes in the study of hormones — a pediatric endocrinologist. Sometimes body odor can be the first sign of something called premature adrenarche, when glands are stimulated and cause growth of pubertal hair under the arms and in the genital area at an early age. Other signs of early pubertal development may also be present. There are multiple causes of premature adrenarche. A pediatrician and a pediatric endocrinologist are the right people to see if you have cause to investigate further. Q3. My friend has a 22-month-old daughter who is not crawling, scooting, or walking and has never even pulled herself up to a standing position. Her child doesn’t babble, coo, or make words. I am worried; however, my friend says there is nothing wrong with her child. Her daughter has very stiff arms, hands, and fingers, and cries when you hold her hand to help her stand up or encourage her to walk. Do you have any suggestions for my friend? — Maxine, Virginia Your concerns about your friend’s daughter are well founded. Pediatricians closely watch children’s developmental progress because developmental delays are common and often respond well to early intervention. Although many children will have mild developmental delays, such as a speech delay, significant delays in speech and motor skills should be taken seriously and evaluated. The typical child starts crawling at around 8 to 10 months and walks at around 12 to 13 months, so your friend’s daughter has very delayed motor skills. Cooing usually begins at about 2 months, and babbling occurs at around 6 to 8 months. Most 12-month-olds can at least say “Mama” and “Dada.” Your friend’s child has clearly not achieved many motor or speech milestones. These significant developmental delays, combined with the stiffness in the arms that you describe, are particularly worrisome — they may be caused by cerebral palsy or another neurological problem. It is unusual that her mother is not concerned about these developmental delays. Most mothers are very good at detecting even subtle delays. I’m not sure why your friend hasn’t sought help. I suggest you approach the topic carefully. You might ask her if she has discussed her child’s delays with her pediatrician. She really should have her daughter evaluated by a pediatric neurologist or a behavioral and developmental specialist. Physical therapy, occupational therapy, and speech therapy can make impressive improvements in children’s capabilities. Getting a child help as soon as possible can improve the outcome, so try to get your friend and her child evaluated and connected with the appropriate resources! Q4. I have a 3-year-old grandson who gets quite a lot of nosebleeds. Could you please tell me if this is something to be concerned about, or will he outgrow it? Many children have frequent nosebleeds, especially in winter. Usually there is nothing to be worried about. Often children rub or pick their noses, which causes bleeding. These types of nosebleeds may last for seconds to minutes but stop without much effort. I often recommend that parents (and grandparents) try to discourage the child from nose picking and consider putting a little Vaseline on the inside of the nose to keep it moist. The blood vessels on the inside of the nose (especially the front part of the septum) are particularly fragile and prone to rupture and bleeding after sneezing or rubbing. Patients who experience very frequent nosebleeds from this area are often referred to an ENT doctor who cauterizes the area. Rarely, nosebleeds can be a sign of a bleeding disorder. Such nosebleeds are difficult to stop. They may also be associated with other signs of bleeding problems, such as frequent skin bruising, or gums that bleed easily. If your grandson has any of these symptoms — nosebleeds that are difficult to stop, bruising, and/or gum bleeding — he should be evaluated by a physician. Again, a nosebleed in and of itself is usually not worrisome, but if you are concerned or have questions, it can’t hurt to have your grandson evaluated by his pediatrician! Q5. I took my 11-year-old daughter to an orthopedic specialist after she complained of back pain. The doctor said she has the back of a 75-year-old woman, plus scoliosis. He said she has a degenerative bone disease. How common is this among children, and how is it treated? What does this mean for my daughter when she becomes an adult? — Angie, Illinois Given the information you’ve provided, I am unsure about your daughter’s diagnosis. There is no specific condition called degenerative bone disease. You mention that your daughter has the “back of a 75-year-old woman,” but that is also vague. Common adult back problems in the elderly include degenerative joint disease and osteoporosis. Degenerative joint disease involves loss of the cartilage cushion in joints. It is rare in children because it is caused by wear and tear on joints, which, obviously, takes years to develop. Osteoporosis, a disorder characterized by weak bones, is also uncommon in children and usually is not associated with pain unless a patient develops fractures. You do mention that your daughter has scoliosis, a curvature of the spine; this is a common back problem in pediatrics, especially among teenage girls. However, scoliosis usually does not cause pain. Unlike adults, children do not often have back pain. If a child complains of back pain, he or she should always be evaluated by a doctor! It could be something serious. I recommend that you seek clarification from your daughter’s doctor to better understand what her exact diagnosis is and how best to best manage her condition. Q6. My 3-year-old started preschool and has been sick ever since. She has had her tonsils and adenoids removed because she constantly spikes a fever of 103 to 104.5 degrees. She recently had pneumonia and spent five days in the hospital. We are just torn up about this. She was never sick until she started school. Should we take her out of school and let her immune system build up and put her back in school at age 5, or is there an underlying problem that her pediatrician is missing? — Andre, South Carolina Andre, you are describing a phenomenon that I commonly see as a pediatrician. Children in day care and in preschool often get many infections each year. Infection is especially common at this young age because children often put things in their mouth and have not built up the immunity to fight off many common viral infections. It is actually normal for a young child to get an average of eight to 10 colds per year. If your daughter is getting typical infections such as colds and stomach infections, then she is dealing with common infections that all children, even those with good immune systems, get when they are exposed to new viruses and bacteria. Some young children even get pneumonia, which is also normal if it happens only once. If, on the other hand, your daughter is getting recurrent pneumonias, recurrent skin infections, infections in her blood, or multiple infections that require hospitalization, then you should have her evaluated more carefully for a possible immune problem and consider delaying school until she is a little older. In general, the best way to prevent infection is consistent and thorough hand-washing. Teach your children not to put their hands in their mouth, rub their eyes, or pick their nose. Mouths, eyes, and noses are all ways that bacteria and viruses can enter a person’s body. If you have any specific questions about her general health, you can have her evaluated by her pediatrician. Her doctor may want to order a complete blood count to make sure everything is normal and consider testing to see if she has made antibodies to her vaccines, a sign that her immune system is likely functioning well. I would certainly recommend that you speak with her pediatrician before you decide to take her out of school because of all of her infections. Q7. I watch a 6-year-old child who has nocturnal incontinence. Recently, she has started to have accidents during the day. She either doesn’t know she has to go or she just can’t hold it. Her parents have been informed of the problem and have yet to make a doctor’s appointment. What can I, as her caretaker, do to help? I limit her drinks and have her go to the bathroom before bed, but she still soaks the bed within two hours. I understand your concern. Bed-wetting at night, also called nocturnal enuresis, is common in children. However, if a child has been toilet trained and doesn’t have accidents during the day but suddenly seems to regress and starts having accidents both in the daytime and at night, it certainly should be investigated. There are many things that could be causing the problem. A urinary tract infection is one of the most common reasons children suddenly have toileting accidents. Some children who become very constipated can have problems with both bowel and bladder control. Occasionally, stressful things in a child’s life, like parents getting divorced, or even abuse, can lead to regression in toileting skills. Rarely, children can have a hormone problem, such as diabetes, that makes them drink and urinate more. I agree with your recommendation that this child should be evaluated by a doctor — continue to encourage the parents to make an appointment! Q8. My 2-year-old son occasionally wakes up with partial paralysis. He will wake up suddenly after two to four hours of being asleep unable to use his left side. Within 10 minutes he is able to move his left side again and falls back to sleep quickly. My wife has noticed that this usually happens when he has had more than two late nights. We are concerned about this behavior and worry that it may be caused by seizures or a night terror type sleep problem. Should we be worried about something serious or just make sure he gets good sleep? Adam, I definitely recommend that your son be evaluated by a neurologist. Paralysis of one side of the body is not a common occurrence. As you mentioned, it could be associated with a seizure. The paralysis may be the actual seizure or something that occurs after a seizure has finished, which is called Todd’s Paralysis. Paralysis of one side of the body is not seen with night terrors, however it can occur in a disorder called sleep paralysis. Sleep paralysis may be associated with narcolepsy or it may be an isolated symptom. The theory behind this phenomenon is that during sleep the body does not move because of a natural paralysis. In sleep paralysis, a person wakes up, but still is in a paralytic state. These episodes occur during the transition from sleeping to wakefulness and usually resolve in 10 minutes although they may last as long as one hour. This disorder most often occurs on both sides of the body, however. Both seizures and sleep paralysis may be worsened by sleep deprivation. I encourage you to keep your son well rested and take him to a neurologist to get a proper diagnosis! Q9. My daughter, who is 8 and a half months old, has recently started making constant circular movements with her right wrist. Sometimes her right leg bounces with it. It started out when she was excited. Now she does it constantly, and it gets more severe when she is excited or nervous. It is very unnerving to watch. Is this normal or should I have her examined by a pediatric neurologist? Infants often make repetitive movements. If your daughter is alert when she is moving in this way, and if you are able to stop her by gently applying pressure, then the movements are likely just behavioral. If, however, she seems less alert, is staring off to the side, or is nonresponsive during the movements, she could be experiencing a seizure. Since the movements are increasing in frequency and you seem to be concerned by them, I would definitely have your daughter evaluated by either her pediatrician or a pediatric neurologist. I recommend you videotape the movements and bring it to your daughter’s doctor to help explain what you’re seeing. Q10. My son of just under a year keeps getting ear infections. Almost every month he gets one and his doctor just did a CBC. While he was sick and had a fever of 104.6, his white blood cell count was low. Should I have this tested again when he is well, or is it likely that it’s just the result of his infection? — Stephanie, Florida Stephanie, I think your son’s white blood cell count was low because he had an infection. I do not think that the low white blood cell count is related to your son’s frequent ear infections. It is common for white blood cell counts to be low with viral infections. Usually I recommend that the white blood cell count be followed up in one to two months to make sure it normalizes. As long as the repeat value is normal, it does not need to be tested again. Just make sure when you return to recheck the value that your son does not have an illness at that time or else the value might be abnormal again! Learn more in the Everyday Health Kids’ Health Center.
