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Questions & Answers by Susan J. Margolin, M.D., M.P.H. If you have a question for the pediatrician, please e-mail it to ESALAMON@SBHCS.COM or mail it to Elizabeth Salamon, Public Relations, Saint Barnabas Medical Center, 95 Old Short Hills Road, West Orange, NJ 07052 Questions should be applicable to children in general, and not focused on the specific case of an individual child. Dear Dr. Margolin, Q. Last winter my 4-year-old daughter had a cough that lasted almost four weeks. I now wonder if she might have had pneumonia, since I came down with viral pneumonia shortly afterward. How can you tell if a child has pneumonia? Does a chest x-ray need to be done? A. It is often difficult to determine if a cough is present because a child has pneumonia or because there is a prolonged reaction to a simple cold. The symptom most often associated with pneumonia in childhood is a rapid respiratory rate, simply breathing fast. Other indications of pneumonia mightbe a fever, flaring of the nostrils with breathing or noticeable use of the muscles of the neck and chest with breathing. When your physician listens to the child’s chest he/she may hear the sounds associated with pneumonia and may choose not to obtain a chest x-ray. A diagnosis based on clinical findings may be sufficient. Should your doctor not hear those sounds (and often in clinical practice one cannot) he may choose to send a child for the x-ray to determine the diagnosis.
Dear Dr. Margolin, Q. We learned my son was lactose intolerant when I started transitioning him from breast milk to formula, which resulted in terrible diarrhea. Now we try to give him only lactose-free dairy, but he still has occasional bouts of diarrhea. My parents think my son may have a milk allergy. Is this different from lactose intolerance? If so, how, and what is the recommended treatment? A. Lactose intolerance is the inability to digest lactose, the sugar in milk and milk products. Milk intolerance or “allergy” can occur either from an inability to digest lactose, or from an intolerance to the protein in cow’s milk and the formulas made from cow’s milk. Diarrhea can result. It is unusual for infants to have lactose intolerance unless there has been prolonged diarrhea. Lactose intolerance is common in 15 percent of adult Caucasians, 40 percent of adult Asians, and 85 percent of African-Americans in the United States. However, this intolerance does not usually begin until older childhood or early adolescence when lactase, the enzyme that breaks down lactose, becomes deficient in the gastrointestinal tract. About 2-3 percent of infants and toddlers will have a cow’s milk protein allergy, or inability to tolerate the protein in cow’s milk. The “cure” is to replace a cow’s milk-based formula with a product that contains soy protein and to see if the child improves. A very small group of children may also have an inability to tolerate the soy protein. Your physician can then recommend another product. [ top ] |
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