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Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

Daily Dose

Coronavirus

1:30 to read

Coronavirus is here…does that cause you concern?  It is causing a lot of concern among mothers in my practice and community as they are posting “my son has coronavirus”. Of course that leads to a Google search and the next thing you know I have parents calling concerned about SARS! (a rare complication).

 

Coronavirus (which is named for the crown like shape of the viral particles under a microscope) is just another fall and winter virus that typically causes cold like symptoms with a scratchy throat, congestion, runny nose and cough. It may also cause several days of fever.  Coronavirus “acts” like many of the other viruses that we are seeing now, including rhinovirus and parainfluenza.

 

While most everyone gets a  coronavirus infection in their lifetime, knowing the name of the virus really doesn’t change anything about the treatment. Having your child’s nose or throat swabbed and sent for a fairly expensive test so that “you may have peace of mind” does not dictate any different treatment than that of any other respiratory virus.  Symptomatic relief has been the advice for treating all of these upper respiratory infections….long before we could test for them in an office setting. 

 

How do you treat it?  Treat the fever if there is one and do not send your child to daycare or school until they have been fever free for 24 hours (you also need to stay home if you have a fever). Use over the counter saline nose drops to help suction your child’s nose or to help thin the mucous so that they can “blow” more effectively. Take a steamy shower to relieve the congestion and loosen the cough. Use a cool mist humidifier in your child’s room (especially if you have the heat running). Make sure to teach your children how to “cough into their elbow” rather than their hands. 

 

I am continuing to hold a lot of hands as parents worry about all of these different respiratory viruses….but naming them is not going to change treatment in the otherwise healthy child. Making sure your child washes their hands and try to teach your older children to keep their hands away from their eyes, nose and mouth will serve you better than worrying about which virus they may have been exposed to. 

 

In the case of any illness, if you become concerned about how your child is breathing and respiratory distress, you need to place an immediate call to your pediatrician or a visit to the ER.  Do not be soconcerned about naming the illness. 

 

 

 

 

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Daily Dose

CPR

1:00 to read

I was seeing a newborn the other day and the parents had a great idea. Their baby had spit up and they were concerned about how to clear his airway.  When we discussed how to hold the baby to clear the airway they had the great idea of having a CPR “teaching party” for a group of their friends who also had young babies!

 

I do encourage new parents (actually all parents and even grandparents) to take a CPR class. I am fortunate that we have yearly CPR class in our office which keeps us all up to date. 

 

It is fairly easy to find local CPR classes either through the YMCA, the American Heart Association and often through the hospital where you deliver your baby.  But, in these cases you have to take the class on “their schedule”. What a great idea to host a party with your friends and hire a certified CPR instructor to come to you!!

 

You know I do like to “isolate” my newborn patients from crowds (for 6-8 weeks), but it is fun to gather with other parents of newborns to get some social interaction. If everyone brought their baby, and a dish for dinner, it could be a mini dinner party followed by CPR training….ending with wine!

 

So…let’s start planning CPR parties, I may even do one for my friends who are becoming grandparents!

 

 

Daily Dose

How to Treat Poison Ivy

1.15 to read

With the long weekend here, many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your child has come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

Daily Dose

Swollen Lymph Nodes

1:30 to read

A parent’s concern over finding a swollen lymph node, which is known as lymphadenopathy, is quite common during childhood.  The most common place to notice your child’s lymph nodes are in the head and neck area.

Lymph nodes are easy to feel  around the jaw line, behind the ears and also at the base of the neck, and parents will often feel them when they are bathing their children.  Because young children get frequent viral upper respiratory infections (especially in the fall and winter months), the lymph nodes in the neck often enlarge as they send out white cells to help fight the infection. In most cases these nodes are the size of nickels, dimes or quarters and are freely mobile. The skin overlying the nodes should not appear to be red or warm to the touch. There are often several nodes of various sizes that may be noticed at the same time on either side of the neck.   It is not uncommon for the node to be more visible when a child turns their head to one side which makes the node “stick out” even more.

Besides the nodes in the head and neck area there are many other areas where a parent might notice lymph nodes.  They are sometimes noticed beneath the armpit (axilla) and also in the groin area.  It your child has a bug bite on their arm or a rash on their leg or even acne on their face the lymph nodes in that area might become slightly swollen as they provide an inflammatory response. In most cases if the lymph nodes are not growing in size and are not warm and red and your child does not appear to be ill you can watch the node or nodes for awhile.  The most typical scenario is that the node will decrease in size as your child gets over their cold or their bug bite.  If the node is getting larger or more tender you should see your pediatrician. 

Any node that continues to increase in size, or becomes more firm and fixed needs to be examined. As Adrienne noted in her iPhone App email, her child has had a prominent node for 7 months. Some children, especially if they are thin, have prominent and easily visible nodes.  They may remain that way for years and should not be of concern if your doctor has felt it before and it continues to remain the same size and is freely mobile.  Thankfully, benign lymphadenopathy is a frequent reason for an office visit to the pediatrician, and a parent can be easily reassured.

That's your daily dose.  We'll chat again tomorrow.

Daily Dose

Chapped Cheeks

1.15 to read

Weather is crazy around the country and those cold temps continue. It was in the 80s this past weekend in Dallas but heading to the 20s this week!This really cold and dry winter has been hard on skin and I have seen more babies like this one who are coming in due to having “red cheeks”.  

These precious little red cheeks are just dry and chapped.  The toddler set seems be particularly affected as they are always getting their faces wiped!! Between those winter runny noses which parents are constantly having to wipe and the wiping of faces after finger foods have been “smeared” from cheek to cheek, a toddler’s face gets lots of wear and tear.

While it would seem that water on the face from lots of washing would be hydrating, it is actually not. At this time of year, a little less face washing is beneficial, but what toddler can go for more than an hour or so without having something washed off their face.

So to counteract all of the dryness requires lots of hydration with moisturizers. Right after washing, wiping your child’s face you need to use a thick moisturizer.  You cannot over moisturize your child during this time of year.   I am a fan of Cerave Cream and Aquaphor.  I often use Cerave (cream is thicker than the lotion) during the day and then lather on Aquaphor at bedtime!!  The thick moisturizer helps hold the water into the skin.   I was even known to rub Aquaphor on my own’s childrens’ faces once they were asleep, so they were not tempted to rub it off!!

Don’t worry, once the weather warms up, the heat is off and the humidity starts those rosy little cheeks will fade away....unless that is you don’t use sunscreen, but that is another blog!!

Daily Dose

Don't Let Your Child Become an Obesity Statistic

Healthy eating begins with the first foods that you feed your infant.An alarming statistic was released today which shows that one in five 4-year-old children are obese and these numbers are even higher in minority children. This study was just published in The Archives of Pediatric and Adolescent Medicine, and followed over 8,000 children looking at height and weight. The findings were quite concerning, showing a trend toward obesity at an age younger than predicted, and numerous long term health problems associated with obesity, such as heart disease, diabetes, high blood pressure and bone and joint problems.

This is a national health issue and a call to action for all families to teach and model healthy eating. One of the problems is that many of the government sponsored food programs provide foods high in carbohydrates, and low in fresh fruits and vegetables, and this promotes obesity. School lunches have also been found to be high in fat and carbohydrate and continue to promote poor food choices. With the bad economy and recession, families have cut back on groceries and may be eating more fast foods, breads and pastas, again providing more carbohydrate than protein. Healthy eating begins with the first foods that you feed your infant. A well balanced diet with grains, fruits, vegetables and meats begins in the high chair and should continue at the family dinner table. The meals may be simple and healthy. Being a short order cook, or providing your child's favorite pizza and fried food on a daily basis, even in a young toddler will have deleterious effects for the rest of their life. Don't let your child become a statistic heading toward lifelong health issues secondary to childhood obesity. Change your own eating habits, improve your children's and remain committed to family meals. We, as parents, cannot afford to raise a generation where obesity is the norm: the change must begin now. That's your daily dose, we'll chat again tomorrow. More Information: 1 in 5 Preschoolers Obese

Daily Dose

Red Cheeks In Winter

1:15 to read

Why do children get red cheeks in winter?

It is the time of year for cold temperatures, low humidity and dry skin. It is funny, every year as the temperatures drop, I we start seeing these cute little babies and toddlers who have those bright red cheeks. I always say that they “look like British babies”.

Dry skin is just one of the many issues we see with colder temperatures, and babies red cheeks are one of the most evident. During the winter months we all experience dry skin and using moisturizer becomes very important.

I have written previous blogs about eczema, and while chapped skin is not synonymous with eczema, there are some similarities. The most important thing to prevent dry skin while the weather is cold is to use a moisturizer, and applying moisturizer is best on damp skin. After bathing your baby or child, pat them dry until they are just “a tad bit moist” and then take a moisturizer and apply it to the almost dry skin. The thicker the moisturizer the better, so a cream is preferable to a lotion. It will take a little more time to rub the cream in when the skin is a bit moist, but it will help the moisturizer penetrate the skin. The same thing goes for the face.

I always found that the best time for me to moisturize those rosy cheeks was really after the child had gone to sleep. When my children were younger I found that if I put the cream on when they were awake, that they either rubbed their faces more, or if they were verbal, complained about lotion on their faces. So…I decided that it worked best to have their bedtime routine, with baths, books, and prayers, and then once they were asleep I would slip in and lather up their faces and also even used Chap Stick on their dry little lips. Now, there is no science in this routine, but it seemed to work, and they were much more tolerant of lubricants when asleep than awake.

We are definitely in the low humidity season and the heat is on in the house (I am typing this as I sit by the fire with a blanket over my feet), so you can expect several months of dry skin and chapped cheeks. If moisturizers like Vanicream, Cerave, Aquaphor and Eucerin go on sale, stock up!!  April is a long way away.

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Daily Dose

What a "Bald Spot" Can Mean for Kids

I saw a patient the other day whose mother brought him into the office after her son had found a “bald spot” on his head. It is alarming for parents or a child to find an area of hair loss or a “bald spot” on their head.

One of the reasons for hair loss is called alopecia areata. Alopciea areata is a non-scarring, solitary or multiple circular patch of hair loss. The areas are often described as "coin-shaped", often the size of a nickel or quarter, but may be larger. Alopecia areata is an immune disorder typically seen in children and adolescents. It can run in families and stress may play a role as a trigger. The areas exhibit no scaling, scabbing or irritation, there is simply hair loss. In older adolescents and young adult males the disorder can occur in the beard areas around areas of hair loss. Most of the lesions will resolve within a year, but patients often have repeat episodes. Rarely the hair loss can progress to total loss of scalp and body hair. Parents often confuse the hair loss with the fungal disease known as "ringworm", but alopecia areata is not related to a fungus or any other known contagious disorder. There is no cure for Alopecia areata, but there is treatment. The most common treatment consists of steroid injections into the areas. There can be significant psychological issues associated with the cosmetic consequences of alopecia areata and parents should be aware of that when deciding whether to treat the areas or wait for spontaneous resolution. In this case I sent him on to a dermatologist for further evaluation and treatment. The good news is that the majority of cases will resolve. Like so many things it takes time and patience and that is hard to have if you are a teen with hair loss. That’s your daily dose, we’ll chat again tomorrow.

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Your child has Coronavirus. Now what?

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