Daily Dose

Summer Skin Infections

1:30 to read

I have been seeing a lot of skin infections and many of these are due to community acquired methicillin resistant staph areus (caMRSA). The typical patient may be a teen involved in sports, but I also see this infection in young children in day care, or summer camp. The typical history is “I think I have a spider bite” and that makes your ears perk up because that is one of the most common complaints with a staph infection, which is typically not due to a bite at all.

The poor spider keeps getting blamed, and how many spiders have you seen lurking around your house waiting to pounce? The caMRSA bacteria is ubiquitous and penetrates small micro abrasions in the skin without any of us every knowing it. The typical caMRSA infection presents with a boil or pustule that grows rapidly and is very tender, red and warm to the touch. The patient will often say that they “thought it was a bite” but the lesion gets angry and red and tender very quickly and typically has a pustular center.

For most of us pediatricians, you can see a lesion and you know that it is staph. It is most common to see these lesions in athletes on exposed skin surfaces such as arms and legs, but lesions are also common on the buttocks of children who are in diapers in day care. The area is angry looking and tender and the teenage boy I saw the other day would not sit on the chair, but laid on the table on his side as he was so uncomfortable. If the lesion is pustular the doctor should obtain a culture to determine which bacteria is causing the infection, but in most cases in my office the culture of these lesions comes back as caMRSA or in the jargon Mersa. When I say Mersa, I often cause widespread panic among my patients, but in most cases to date these infections may still be treated with an oral antibiotic that covers caMRSA, such as clindamycin or trimethoprim-sulfa. Many of the lesions improve dramatically once the site is drained and cultured. I will reiterate that if possible you want your doctor to obtain a culture to identify the bacteria that is causing the infection.

To prevent caMRSA remind your student athlete not to share towels, clothing or other items. Make sure that common areas are disinfected and once again encourage good hand washing. The closure of schools or disinfecting an entire football field or area with turf is not recommended. Lastly, this is a good reminder that you only want to take an antibiotic for a bacterial infection and that overuse of antibiotics leads to resistance. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Treating Bee Stings

Bee stings are a right of passage during childhood, always memorable, but never fun.I was outside today and noticed that the bees are back, pollinating the flowers in my garden, but ready to sting too if they are crossed by bare feet or errant hands. Bee stings are a right of passage during childhood, always memorable, but never fun. Our office receives numerous calls about how to handle a bee sting. First thing is to get some ice or a cool compress on the sting, which relives both PAIN and swelling.

While the ice is working you can take a peek and see if the stinger is still in the skin, and if so do not go grab tweezers or your fingernails to try and remove the stinger. If you do that you will only make the sting worse. The best way to remove the stinger is by using the edge of a credit card to gently scrape the stinger out of the skin. Honey Bees leave behind their stinger while wasps and hornets do not. Unless the child is allergic to bee stings most people will only have a local reaction. If there are any symptoms associated with the sting such as swelling of face, mouth, lips, or difficulty swallowing or breathing, give an immediate dose of Benadryl (diphenhydramine) while calling 911. If the child has a known bee hypersensitivity and they have an epi pen you will need to use it and also call 911. For local reactions after the sting is cleaned you can apply calamine lotion or a topical steroid cream. For swelling and discomfort a dose of Benadryl is also recommended, as well as a pain reliever like ibuprofen which will also relieve local inflammation along with pain relief. The sting is usually not uncomfortable for more than 24 hours. Make sure to watch for signs of infection with increasing redness, streaking or pain at the site of the sting. If the area seems to be getting worse rather than better it is a good idea to let you pediatrician take a peek. That's your daily dose for today, we'll chat again tomorrow.

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Daily Dose

4th of July Celebrations!

1:30 to read

The 4th of July weekend is right around the corner, which means many families will celebrate with a long weekend with other families and friends. Let’s remember the importance of making it a safe holiday!   

Of course the celebration includes fireworks which are definitely fun to watch, but at the same time, when they are used by consumers (many of whom are children and teens) rather than by trained professionals, there are many associated risks.  Being on call in the ER as a new doctor was one of the scariest and longest nights in my life...and I can remember seeing children with burns...several which were disfiguring. Burns remain one of my biggest fears.

In 2013 there were an estimated 11,400 people treated in emergency rooms for fireworks related injuries, and the risk of fireworks injury was highest for children ages 0- years, followed by children 10-14 years. I know that having fireworks in your backyard or on the beach is fun, but also dangerous. Although I was used to my boys saying, “ Mom, you tell us that everything that is fun is too dangerous...which not only included fireworks, but trampolines, and motorcycles.”  I am sticking to that.

The majority of fireworks related injuries were to the extremities followed by those to the head (eyes, ears, face).  The greatest number of injuries were caused by small firecrackers, sparklers, and bottle rockets. Did you know that a sparkler burns as hot as 1200 degrees F, while water boils at 212 degrees F and wood burns at 575 degrees F!! Even a left over sparkler may cause a significant burn to little hands.

Fireworks are best left to the “hands” of the experts. Fireworks are dangerous and can be unpredictable, especially in the hands of amateurs (including parents).  Public firework displays are equally enjoyable and are carefully planned and executed. Especially with drought conditions and fires already raging in parts of the U.S. it is especially important to be aware of the risk of inadvertently setting a small fire from a misguided bottle rocket.  That small fire may lead to an even bigger fire which destroys acres of land as well as puts firefighters themselves at risk. No one wishes for that scenario but there were over 17,500 fires caused by fireworks in previous years. 

Start planning your holiday fireworks viewing now....from a safe venue! Happy 4th!

Daily Dose

Moles On A Child's Skin

1:30 to read

Everybody gets moles, even people who use sunscreen routinely. Moles can occur on any area of the body from the scalp, to the face, chest, arms, legs, groin and even between fingers and toes and the bottom of the feet.  So, not all moles are related to sun exposure.

Many people inherit the tendency to have moles and may have a family history of melanoma (cancer), so it is important to know your family history. People with certain skins types, especially fair skin, as well as those people who spend a great deal of time outside whether for work or pleasure may be more likely to develop dangerous moles. Children may be born with a mole (congenital) or often develop a mole in early childhood. It is common for children to continue to get moles throughout their childhood and adolescence and even into adulthood.

The most important issue surrounding moles is to be observant for changes in the shape, color, or size of your mole. Look especially at moles that have irregular shapes, jagged borders, uneven color within the same mole, and redness in a mole. I begin checking children’s moles at their early check ups and look for any moles that I want parents to continue to be watching and to be aware of. I note all moles on my chart so I know each year which ones I want to pay attention to, especially moles in the scalp, on fingers and toes and in areas that are not routinely examined. A parent may even check their child’s moles every several months too and pay particular attention to any of the more unusual moles. Be aware that a malignant mole may often be flat, rather than the raised larger mole. Freckles are also common in children and are usually found on the face and nose, the chest, upper back and arms. Freckles tend to be lighter than moles, and cluster. If you are not sure ask your doctor.

Sun exposure plays a role in the development of melanoma and skin cancer, so it is imperative that your child is sun smart. That includes wearing a hat and sunscreen, as well as the newer protective clothing that is available at many stores. I would also have your child avoid the midday sun and wear a hat. Early awareness of sun protection will hopefully establish good habits and continue throughout your child’s life.

That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Have Your Child's Blood Pressure Checked

1:00 to read

When you take your child in to the pediatrician for a check-up do they check their blood pressure? The American Academy of Pediatrics (AAP) recommends that children, beginning at the age of three years, should routinely have their blood pressure checked.  

In certain circumstances a younger child should have their blood pressure checked too. With the growing epidemic in obesity, pediatricians are seeing more children with abnormal blood pressure readings. It is important that the right sized blood pressure cuff is used for measuring a child’s blood pressure. There are standards for blood pressures for different age children. The standards are also based on a child’s height.

When a child’s blood pressure reading is greater than the 90th percentile for their age they are said to have pre-hypertension. The prevalence of childhood hypertension is thought to be between one and four percent and may even be as high as 10 percent in obese children. Obesity plays a role but, related to that is also inactivity among children, diet, and their genetic predisposition for developing high blood pressure. Then it is appropriate for further work up to be done to evaluate the reason for the elevation in blood pressure.

If I find a child with a high blood pressure reading during their physical exam, it is important to re-take their blood pressure in both arms. I also do not depend on automated blood pressure readings, as I find they are often inaccurate and I prefer to use the “old fashioned” cuff and stethoscope to listen for the blood pressure. If the blood pressure reading is abnormal, then I have the child/adolescent have their blood pressure taken over a week or two at different times of the day. They can have the school nurse take it and parents can also buy an inexpensive blood pressure machine to take it at home. I then look at the readings to confirm that they are consistently high. The “white coat” syndrome, when a doctor assumes that the elevated blood pressure is due to anxiety, may not actually be the case, so make sure that repeat blood pressures are taken. If your child does have elevated blood pressure readings it is important that further evaluation is undertaken, either by your pediatrician or by referral to a pediatric cardiologist.

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Your Teen's Eating Habits

1:30 to read

While seeing patients one evening, I saw a 15 year old boy who had come in complaining of feeling dizzy and tired. It was the end of school as well, so he was busy with studying and finals.  This is the kind of patient that is typically given a 15 minute appointment.....but needs a lot more than that to figure out what is going on.

He was with his father who said that his son had not had a fever, had not otherwise been ill with cough or cold symptoms. Upon further questioning the teen said he was just tired and thought he might faint....although he had not.  He had gone to school that day. He was not involved in athletics and had no history of previous syncope (fainting). There was not a history of sudden cardiac death in the family. He also had a fraternal twin who was healthy. He usually tried to get about 6-8 hours of sleep a night. He denied drug or alcohol use. He had not had weight loss. HIs exam was entirely normal with normal vital signs.

But, when questioned about his eating habits he informed me that he was a vegan.  His father sat there quietly while I discussed his son’s choices.  He said that he had decided to be a vegan about a year prior, and that he rarely ate with his family. When I asked him to give me an idea of a typical breakfast, lunch and dinner I was amazed at what I heard. He really only ate “junk food”. He ate sugary cereal for breakfast, he might eat a veggie burrito for lunch, and he would often eat another fast food burrito or taco for dinner. He did not eat fruit at all. His Dad said that everyone else in the family ate “normal” meals, and that they were offered to his son as well.

I am writing this to illustrate one of the problems I see with teens who decide to become vegetarians or vegans etc, but really are just what his Dad so correctly stated are “junk food vegans or vegetarians”.

After a lengthy discussion and some lab work,  he was sent home with instructions to research ways to improve his diet even as a vegan, which in turn would probably help his fatigue. He was also stressed about the end of school.... which was another discussion as well!

Both eating issues and stress cause teens to have a lot of complaints of fatigue and feeling blah...I see them all day long. This adolescent agreed to   come back in a month with his diary of meals and he is going to see our nutritionist over the summer.

He was a delightful young man....and I was only an hour behind...but at least we got to the bottom of the problem.

Daily Dose

Poison Control in Your Home

1:15 tow atch

Our office gets many calls from parents who are worried that their child may have swallowed a stray pill, or a berry or plant leaf.  The list is endless. Despite every parents efforts at childproofing their home (childproofing cabinets, electrical outlets etc, should begin as your your-baby starts to crawl) at times a toddler finds something stray and the first place it goes is in their mouth.

The phone number that needs to be at every parent's fingertips is the number to the Poison Control Center. That number is 1-800-222-1222 and should be on your speed dial or on a sticker on your phone.

The poison control center is the national source for information on poisoning and I have been so impressed with their professional, yet compassionate manner and their knowledge base. If your child does accidentally ingest a household cleanser, or a drug have the bottle handy when you call them so that you can read them the label. It is much easier for them to help you decide what to do for the ingestion with complete information. Telling them that it was a small white pill leaves millions of possibilities; so make sure that you do keep all medications, whether over the counter or prescription, in their appropriate bottle. Fortunately, many ingestions may be benign and require no treatment, but do not assume this until you have spoken with Poison Control. The use of syrup of ipecac, to induce vomiting after ingestion is no longer recommended. Thank goodness!

That's your daily dose, we'll chat again tomorrow.

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Daily Dose

Teaching Good Playground Manners

We saw democracy at work yesterday and this is a good time to parlay those lessons to our children and the playground. Teaching our kids to play nicely with one another and to be inclusive begins in toddlerhood and continues throughout their childhood. Children need to learn to share the swings and monkey bars, and to invite others to play with them. The sandbox is another great place to learn to play in unison, while working together to build castles and cities in the sand. It is easier to build a city with a group than alone.

Play with your children on the playground so that they may watch how you interact with other children and share and involve others while playing. Young kids need to learn that pushing, hitting and bullying is not appropriate. It is age appropriate for young children to show some of these inappropriate behaviors, but with parental guidance children learn the importance of sharing and how to manage group play. By the time your child reaches elementary school these appropriate play behaviors should be instilled in them. Keep practicing. That's your daily dose, we'll chat tomorrow.

Daily Dose

When Bug Bites Get Infected

1.00 to read

It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions. 

The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks.  This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed. 

Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that “baby fat” reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites. 

Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer. 

Severe local reactions are called “skeeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms  (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from infection.

Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins, but are extremely rare. 

The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion, Sarna lotion and Dommeboro soaks.  This may be supplemented by topical steroid creams (either over the counter of prescription) to help with itching and discomfort. 

An oral antihistamine (Benadryl) may also reduce some of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites. 

Due to an exceptionally warm winter throughout the country the mosquito population seems to be especially prolific. The best treatment is prevention!! Before going outside use a DEET preparation in children over the age of six months, and use the lowest concentration that is effective.  Mosquito netting may be used for infants in strollers.  Remember, do not reapply bug spray like you would sunscreen. 

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