A. Your family doctor can get you started on this kind of evaluation. A standard physical exam is unlikely to reveal the exact cause of the problems you are noticing, but will give an assessment of general health. Lab tests will likely be ordered. Standard blood tests would include a blood count (red cell count, white cell count), a chemistry panel measuring liver and kidney function, blood glucose, and thyroid function. In younger children it will likely include a blood or urine test to measure for any toxin exposure (lead poisoning is not uncommon in some areas of the U.S.) and in adolescents will likely include a test for the use of illicit drugs. If these tests are normal, referral to a psychiatrist is likely. A neurologist may also be consulted if any questions remain from the screening process described.

HELPFUL WEBSITES:

• http://www.psych.org/public_info/fam_and_child.html
• http://www.ncpamd.com/books.htm

MEDICAL REFERENCES (usually available through the library of your local hospital):

• Carson AJ, Ringbauer B, MacKenzie L, Warlow C, Sharpe M.
  Neurological Disease, Emotional Disorder, and Disability: They Are Related: A Study of 300 Consecutive New Referrals to a Neurology Outpatient Department. J Neurol Neurosurg Psychiatry. 2000 Feb;68(2):202-6.
• Comerci GD, Schwebel R.
  Substance Abuse: An Overview. Adolesc Med. 2000 Feb;11(1):79-101. Review.
• Weller EB, Weller RA, Fristad MA, Rooney MT, Schecter J.
  Children's Interview for Psychiatric Syndromes (ChIPS). J Am Acad Child Adolesc Psychiatry. 2000 Jan;39(1):76-84.

A.I agree that the hearing problem isn't the cause of the speech problem. In fact, you can speak normally even if you are completely deaf in one ear. So her problem is related to something else. Certainly a structural problem (for example a problem with the way her muscles or tongue is formed) is possible, but this is not likely since the doctors cannot find the cause. In any case, it is encouraging that the speech classes have helped.

Your major concern is that she has been targeted because "she is different." Unfortunately, we can't do much to prevent the acts of others, which means we should concentrate on what we can do. First, we can try to minimize her speech problem, which you seem to be doing by seeking medical advice and speech therapy. I would directly address your concerns with the speech therapist and ask for a second opinion if you are not happy.

The other focus should be on how your niece responds to being targeted. Clearly, the early teen years are a very difficult time. Sometimes pointing out how others with similar problems have succeeded helps, but that may not be enough to dry her tears at night. If you have done all you can with the medical and speech therapy options and the loving support of family and friends is not enough, some counseling to help her deal with this stress might be useful.

A.There are a large number (over 50) of spider species that can bite a human. These bites can cause a local reaction (such as an ulcer at the site of the bite of the brown recluse spider) or a generalized reaction (such as the poisoning of black widow). However, a chronic disease, such as the one experienced by your niece, is not usually seen with a spider bite. I have to agree with her doctor that the spider bite is probably not the cause.

A. The bottom line is that you should not be worried now. Your son's head trauma had the potential of causing some serious complications, however all of these complications would have been noted early on (within a few days, if not a few hours of the accident).

These complications, which would be associated with some bleeding, are incredibly rare. The fact that your son did well, even though he did have some mild symptoms for awhile after the accident, says that he is now completely over the injury and there will be no further problems associated with the accident.

A.First, I will assume your child has normal intelligence along with his cerebral palsy. If so, the cerebral palsy has little to do with his problem. (Of course, if his intelligence is impaired, my response will not apply.)

Second, we need to be careful about separating emotions (happy, sad, angry) with the signals the body sends regarding its current state (tired, hungry). It looks as though he has a hard time with the latter. To a degree, some of this is just educational, helping him learn that when he doesn't feel well that may be due to many things (e.g., fatigue, pain, the flu), and teaching him how to tell the difference. I do not believe this particular issue is a major cause for concern. He will learn the distinction in time.

The eating behavior, on the other hand, may be more worrisome. If he is 8 years old and 85 pounds, he may be overweight. This depends on how tall he is. I would check with your doctor. If he height is appropriate for the weight, he is just a big boy. If he is eating a lot it is because he is active and burning the calories, there is no concern.

On the other hand, if he is too heavy for his height, then he has a problem, and you will have to work with him to control his appetite. This is usually first done by getting his cooperation. Most overweight eight-year-olds face peer pressure, and that pressure can help you modify his eating behavior.

A. Yes, pediatricians definitely take care of adolescents. Some pediatricians will even take care of young adults. The question of which type of doctor best serves the adolescent is a complex one. Basically, there are three types of primary care providers that could treat the adolescent. The first is the pediatrician, the second is the family physician and the third is the adolescence medicine specialist. An adolescence specialist is a pediatrician, family physician or internist who develops extra expertise in adolescence by taking additional training.

There is no good research to say which type of doctor takes best care of adolescents. In general, a doctor that can relate to the adolescent is probably going to do the best job. Adolescence is a time of great transition and turmoil, and having a health care partner that the adolescent relates to can be of immeasurable benefit. If you know a few physicians who claim to be able to take care of adolescents, finding the one that the adolescent likes the most will probably be best in the long run.

A.What a great cause! There are several sources of materials. It will help first to decide whether you are interested in physical, mental or all disabilities, as well as those related to specific diseases. Materials for a specific disease can be obtained from the local chapter of its national support group (almost all have support groups). Broader disability material can be obtained by a representative sample of different diseases. (For example, a Crohn's disease group and TERAP, a group for people with agoraphobia. The former is a medical condition; the latter is a psychological condition.). Finally, you can try the Web. Some material is available through the federal government.

A. Excessive sweat production is called hyperhidrosis. It can be either local (palms, axilla) or generalized. By your description, I assume you have a generalized hyperhidrosis. This can be "normal," in other words, we can find no specific cause. Or, it can be caused by emotional factors or any of series of medical problems such as disorders of the thyroid gland or some other common (such as diabetes) or uncommon (like pheochromocytoma) endocrine problems. A good evaluation by your doctor can find if any of these are likely in you.

Treatment of localized hyperhidrosis can be through topical medication or, in severe cases, surgery. Generalized hyperhidrosis is often more difficult to treat.

A brief discussion of both types of hyperhidrosis is available at http://www.dermnet.org.nz/dna.hyperhidrosis/hyper.html. A much more detailed discussion, including the pros and cons related to several treatments, is at http://www.parsec.it/summit/hyper1e.htm.

A. Ear infections at this age are very troublesome. We hate to put anyone, especially a young child, on antibiotics needlessly, especially since in most children the infections will stop by the time they are about 6. At this age the eustachian tube (a small tube that drains the ear and equalizes the pressure in the ear) grows large enough that the infection rate drops).

Your son, however, has two problems. First, there is the recurrent ear infections. Second, there is the cleft palate. While it is possible the cleft palate is causing the infections, we'd want to be sure nothing else is involved. For example, while most 3½-year-olds are no longer on the bottle, a few still use a bottle at night. Some parents smoke. Both of these are associated with increase ear infection rates in children. So if either of these are the case in your house, you might consider making these changes.

After the other causes have been addressed, there is the option of "prophylactic antibiotics." This means we'd treat your son before he actually gets an infection. I know that sounds strange, but it has been used in some cases like this. (I also realize you are interested in DECREASING your son's antibiotic exposure, not increasing it, but prophylactic antibiotics might keep him from getting sick so often). You might consider discussing this option with your son's doctor.

Surgery is another option, but usually we reserve that for only very special cases. That might be your son, but you will want to explore all other options first.

A.An 8-year-old may refuse to eat for several reasons. For example, she may be afraid of vomiting after her illness or she could have a psychologic or psychiatric problem. The main issue, however, is that at this time she is suppose to be eating and growing. Several of her body areas need good nutrition to develop properly. Hiding the food suggests that there could be some deep-seeded psychological process going on. Bulimia may be unusual for an eight-year-old, but it is possible.

The 8-year-old needs to seek professional help. For example, a physician could do an initial screen, making sure no weight has been lost and that the body chemistry is still in order. If symptoms persist, then psychological evaluation could be undertaken. The physician should document changes if the child refuses to eat.