What are causes of bad breath in kids?
Dear Dr. Donya,
I am a mother of two. My son is five and my daughter is three years old. My son suffers from bad breath although I make both children brush their teeth regularly using a special children's toothpaste. I have asked my pediatrician about this and according to him it might be hereditary.
My husband initially used to have this problem but it was solved once he used special toothpaste, as he also suffered from bleeding gums. What would be your advice to solve this problem, and when is the right time to introduce my children to adult toothpaste?
-- J.
Dear J.,
Bad breath in children can be from poor oral hygiene in teeth and gums, recurrent nasal or throat infection, especially concerning the sinus.
I recommend that you buy some dental floss and try flossing his teeth in addition to brushing -- food particles often get wedged between the teeth and start to decay, causing a foul odor. How is his health? Has he had any infections in the throat or nose?
-- Dr. Donya
Dear Dr. Donya,
I read your article in The Jakarta Post identifying the problem of congenital heart disease. I want to know if any congenital heart problem is related to the defect of ductus venosus?
-- Mr. Yudo
Dear Mr. Yudo,
Ductus venosus is a vein passing through the liver and connecting the left umbilical vein from the placenta with the inferior vena cava of the fetus.
After birth, the umbilical cord is cut and the placenta removed, so there is no blood supply to the ductus venosus. It loses its circulatory function after birth and persists as the ligamentum venosum of the liver.
There is one congenital heart disease related to ductus venosus, Total Anomalous Pulmonary Venous Return, or TAPVR, which is a rare condition (1 percent of all congenital heart disease). This condition arises when there is no direct connection between the pulmonary vein and the left atrium.
The location of the drainage of the pulmonary veins is divided into four types; in the infracardiac type (20 percent of TAPVR), the pulmonary vein drains to the portal vein (liver blood vessel), or in the other types to the ductus venosus, hepatic vein or the IVC (in which the main blood vessel from the lower part of body drains to heart).
There will be marked cyanosis (a blue appearance) and severe respiratory distress in the neonatal (newborn) period, which will be worse with feeding and growth failure. Patients with the infracardiac type rarely survive more than a few weeks without surgery.
If you have any more questions, please let me know.
-- Dr. Donya
Dear Dr. Donya,
My son, who is three and a half years old, normally wears glasses for astigmatism. However, he recently broke his spectacles and for the past month has not worn them at all (I have had to postpone visits to the ophthalmologist because of other things at home).
I have suddenly noticed he is stammering a lot and even normal words are coming out with a lot of effort.
Do you think the stuttering is related to the loss of his glasses?
-- V
Dear V,
A child's emotional state has a lot to do with stuttering.
Look for any major changes during the time he started stuttering. Breaking his spectacles could be a possible cause. He may be frustrated at not being able to see well. If that is the cause, when he gets his glasses back he will be better.
You said you have no time to see a doctor. Is something happening at home; such as having a baby or has the babysitter he used to have left him? Stuttering occurs more frequently in boys and no one is sure why. It typically happens at this age and goes away as quickly as it comes. As alarming as it is for parents, it is very important to not make an issue of it. So when you are talking with him and he stutters, do your best to understand him but do not correct him, question him or get frustrated with him.
-- Dr. Donya
Dear Dr. Donya,
I am the mother of a 13-week-old baby boy. Recently I found some swollen lymph nodes in his left groin area. I heard that it could be because of tuberculosis.
-- P.
Dear P,
First of all, I want you to look for any kind of infection, wound or lesion, such as an insect bite, on the left leg. Does he have diaper rash or any rash around the groin?
Secondly, how big is the lymph node? If it is less than 0.5 centimeters, it may be from a nonsignificant cause.
Are there other lymph node enlargements? Did he have any vaccine injections in the buttocks recently? It may be a reaction from the vaccine.
How is his general well-being? If he is active, has no fever and is gaining weight, it may not be serious.
For tuberculosis, the infant gets the infection from contact with a person who has active tuberculosis. Did your son receive his BCG vaccine? If you still suspect tuberculosis, take him to see the doctor, who will perform a physical examination and tests as needed.
Keep an eye on the lymph nodes; if they continue to enlarge or become painful, take him to be examined immediately.
-- Dr. Donya
Dear Dr. Donya,
My daughter is three months old. I had her hair shaved when she was one month old. So far, the hair on the top of her head has grown but lower down it still remains bald. The doctor said that she is lacking calcium and prescribed 200mg calcium carbonate tablets to be taken three times a day. Is it true that the lack of calcium will slow down hair growth? Is the dose too much for her? Should I give it to her continuously? At what age does a child need calcium supplements? Can I give her cod liver oil?
My nephew is six years old and lost two front teeth 4 months ago and new teeth have not yet appeared. Is this normal? Does he need additional calcium supplements? What other vitamins should we give him?
-- S
Dear S,
Calcium is the most abundant mineral in the body. It is found in bones and teeth, helping in the functioning of nerves, the heart muscle, blood clots and cells. The normal requirement of calcium intake is around 500 milligrams per day in infants and children younger than 3 years old. Daily sources of calcium are:
*Non-fat dry milk, reconstituted (1 cup) 375 mg.
*Low fat, skimmed, or whole milk (1 cup) 290 to 300 mg.
*Yogurt (1 cup) 275 to 400 mg.
*Sardines with bones (3 ounces) 370 mg.
*Tofu (4 ounces) 154 mg.
*Shrimps (1 cup) 147 mg.
*Iced milk (3/4 cup) 132 mg.
In my opinion, I don't think slow hair growth has anything to do with calcium. As you see there is calcium in many kinds of food and dairy products. Your daughter also drinks milk which contains plenty of calcium. Giving calcium without a deficiency or clinical signs of low calcium may cause high calcium in blood and can lead to a medical problem.
You can give her cod liver oil but look at the dose of vitamin A. She needs 1500 IU per day.
For your nephew, his permanent teeth will appear soon. Normally the first permanent tooth appears in children around seven years or eight years old.
-- Dr. Donya