Adolescent moods

Adolescent Moods

While adolescence is the time when we are physically most healthy, it is the most difficult emotionally. The adolescent has a number of developmental tasks; becoming used to a markedly changed body, developing their own identity, learning to be able to be intimate, developing a sexual identity and preparing to become economically independent. Recently there has been much interest in a study which showed that a hormone that has a calming effect in young children and adults has the opposite effect in adolescence. This was shown in adolescent mice – it will be some time before it is demonstrated in humans and even longer before anything can be done about it. However, it may explain why adolescents fly off the handle so easily.

Also, sometimes your teenager is in “child: mode" and sometimes in “young adult” mode. It is necessary for adults to work this out and respond appropriately depending on whether it is the “child” or “adult” talking.

Some adolescents have difficulties in completing all the tasks listed above. This may lead to serious consequences (suicide, drug taking, unacceptable risk taking such as driving cars fast) but it is important to realize that most will successfully complete these tasks at their own rate. During this time of uncertainty they may adopt the behaviour of a peer or adult model which can be quite distressing to other family members and friends.

A classic study by Parcel and co-workers in 1977(1) showed that the majority of adolescents wanted their doctors to supply information about drugs, sex, sexually transmitted diseases, birth control and getting along with parents. 1 in5 also wanted help with one (or more) of the following – acne, depression, obesity and sexuality. More recent studies have shown similar results.

If an adolescent is having troubles, a very useful idea is to send them to a service for adolescents only – no parents allowed. These can be found in the telephone book. If you wish to accompany your adolescent, your local doctor is probably the first port of call. Parental presence may stop the adolescent from expressing their true concerns. I might have talked about acne with my parents present, but any of the other topics – NO WAY!

1 Parcel G S, Nader P K, Myer M P. Adolescent health concerns, problems and patterns of utilization in a triethnic urban population. Paediatrics, 1977, 60, 157-164

Food allergy

Three years ago our then 5-year-old daughter was hospitalised with respiratory problems. She was put on oxygen and steroids. Asthma was mentioned but I didn’t want to put her on albuterol and steroids for the rest of her life so our family changed our diet. For 3 years, she has not eaten dairy, gluten or many chemicals e.g. nitrites.

Last weekend at a relative’s house, she ate a taco with just a little bit of dairy in the seasonings for the meat. Next day her eyes were watery, red and swollen. In the past 3 years she has had watery eyes at times (if she ingested some food dyes for instance), but has not had any breathing problems or vomited. 2 days after the taco she vomited and did not try to eat until later that afternoon. That evening she had ear pain for the first time since pre-school. 6 days after the taco she had pink eye.

It would seem that your daughter did have a food reaction although from the timing, pink eye may be a coincidence. The question is: to what did she react? The taco shell probably contained preservatives. Milk allergy is rare (but not unknown) in 8 year olds. As her reaction, although unpleasant, was not life threatening, I would be inclined to expose her to milk and note the response.

To do this, put a few drops of milk on her tongue and see what happens. If there is no reaction in 24 hours try an ounce of milk as a drink. If there is still no reaction, in the next 24 hours, give her 2 ounces of milk and gradually build up in that way.

The next thing I would challenge her with is gluten, as this not usually a trigger for asthma. Again start with a small quantity and build up. If she can tolerate both it is likely that food additives are the allergy-producing culprits.

By the way asthma is not for life. 80-90% of children grow out of it. For children who have asthma early in life (as did your daughter) 50% have grown out of it by 6 years of life.

Best of luck and I would be interested to hear what happens.

Vomiting infant

I have an 8 month-old son who projectile vomits at least 3-4 times a day. I have had him to his Doctor many times now and he just says it is teething and this is normal behaviour.
My son is underweight and I worry about this as well as him dehydrating. I have never seen a teething baby projectile vomit and certainly not multiple times a day, spitting up maybe, but not to this extreme.
He has seen other Doctors in the same office and their opinion is that he has a virus. This has been going on now for 6 months.
What do you think?

I can understand your concerns. If it is projectile vomiting, it suggests he has a high but only partial gut obstruction which is at the bottom of the stomach or in his intestine very soon after. Projectile vomiting is where the vomit comes out like water from a fully turned on hose. It clears the baby’s bib and usually mother’s lap. Copious (and even forceful) vomiting that is not truly projectile suggests gastro-oesophageal reflux (a complex term that I will just call reflux from now on).

Reflux is due to a failure of the valve-like mechanism at the bottom end of the gullet where it enters the stomach. We all suffer reflux from time to time when we can feel fluid coming back up our gullets. Adults just swallow it down again, but babies let it flow out.

I agree this problem is not due to teething. All you get with teething is teeth, misery and excess salivation.

As this has been going on for 6 months, your son should be investigated. The first test should be a barium meal which will show any high gut obstruction and reflux if they are present.

Any high part obstruction will require surgery. Reflux will resolve by itself over the next few months. As he is underweight, a high calorie formula while you are waiting might be warranted. A dietician can help you with this.

Tics

My 4-year-old grandson has just developed a tic. He blinks his eyes a lot. His mother, my daughter-in-law, also has this same tic, so I am wondering if this is genetic? I’d like to learn more about tics in general and what if anything can be done about them. While we have noticed this tic, we have not commented on it to him as we don’t want to call attention to it as assume it is not under his control. Is the right approach?

I read recently that this could be caused by a magnesium deficiency and wonder if you agree with this statement?

Transient tics involving the facial muscles and eye blinking occur in one quarter of children. You have done absolutely the right thing in not drawing his attention to them. Stress usually makes them worse and as he cannot control them, commenting on them will only make them worse too. In fact constantly mentioning them can make them permanent – did this happen to his mother? They usually only last for a few months.

No treatment is effective or needed. They are much commoner in boys than girls.

Tics do occur in some illnesses but if he is otherwise well and does not exhibit any other strange behaviours, looking for these is not warranted.

The fact that his mother has tics also does not necessarily mean that the tics are genetic. Often symptoms that do not appear to have a cause run in families e.g. if mum has a headache when stressed often her children will have headaches with stress.

As regards magnesium deficiency, this can cause epileptic fits and other muscle jerks. However, magnesium deficiency is very rare – I have only seen it in 2 children who had very serious underlying diseases

Strep. throats

6 months ago my son had 90% of his tonsils removed along with the adenoids. He also had a nosebleed fixed. When we came home I noticed his nostril was closed off, well it did not get any better. It is like it was welded together. The Dr. said the scar tissue attached itself to the other side of the nostril. But I think it is something the Dr. did on the day of the surgery. Because it was like that on the same day. Also he has had Strep 4 time since then. Is there anything that I can do to prevent him from having strep so often?

When any part of the body is operated on, it swells. Swelling is a part of inflammation which is the body’s response to any insult such as injury or infection. Thus, the initial blockage was due to this swelling. The swelling would be long gone by now. The attachment now could have happened as the surgeon said although I have never seen such a case. One can function quite well on only one open nostril.

As regards the Strep. throats, penicillin or amoxycillin are very good at treating them. However, your son may be a carrier – when the bugs live in the throat area but do not cause disease. But if he has a virus infection in the throat, like a common cold, this changes conditions in the throat in such a way that the Streps can multiply and then they cause disease. I had some success in getting rid of the carrier state by giving an antibiotic called lincomycin (or its close relative Dalacin-C) while the patient is well.

If the Strep. throats continue, consideration would have to be given to removing the last 10% of the tonsils.

By the way has your doctor proven that the sore throats are due to Strep. by swabbing the throat for laboratory investigation? It can be difficult to tell the difference between a viral throat and a Strep. throat.

Crohn's Disease

I have a 15yr.-old diagnosed as Crohn’s disease 5 years ago. Her bowels were impacted and she spent 5 days in hospital to clean her out for scoping. After 3 years of medicine she saw another Dr. who said she didn’t have Crohn’s because she suffers from constipation and not diarrhea. What do you think?

The 3 most common symptoms of Crohn’s disease are diarrhoea, abdominal (tummy) pain and weight loss. However, it is well known that diarrhoea may not occur. One quarter of Crohn’s sufferers have anal fissures(cracks) which make using the bowels painful. As a 10-year-old, your daughter may have been holding on and not using her bowels because of the pain. This would lead to constipation.

I would be most uncomfortable arguing with a diagnosis of Crohn’s disease made on scoping her bowel, especially if a biopsy of the bowel was taken.

Did she improve with her medication for Crohn’s? If so that is strong evidence that the diagnosis was correct. I gather that the medication was stopped 2 years ago. If she remains well since stopping that does not say the diagnosis was incorrect as Crohn’s has times when it is quiet with no symptoms only to flare again later.

I wish your daughter luck with this unpleasant disease. She needs regular medical review as the symptoms and signs of Crohn’s can be elsewhere than in the gut. Poor weight gain or actual loss may be the main sign in children.

Acne

My son has terrible pimples, and no creams seem to cure or prevent them. His confidence is down, as are his school grades and his self-esteem. He thinks he is ugly and that he’ll never attract girls. Can they be cured, and what can I do to help his emotional problems?

I feel sorry for your son – many of us can remember how miserable pimples made us feel. As you’ve found, creams and ointments are next to useless. He should not squeeze his pimples as this leads to more pimples forming.

Because of the psychological problems you describe, further treatment is needed. Ask your doctor to consider prescribing a daily antibiotic for your son. If that is not successful, ask for a referral to a dermatologist because there is a very effective (but expensive) medication that he/she can prescribe.

Usually, effectively treating the acne (as pimples are called) will improve his psychological health. It may help to have an adult who suffered bad acne talk to your son, especially if he has a photo showing his pimples. He will be able to assure your son that he will eventually grow out of the problem.