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Daily Dose

How to Treat Croup

1.15 to read

Now that the weather seems to change daily, croup season is here. Have you heard the sounds of raspy, throaty voices in your house lately? This "noise" is ushering in croup season! Croup is an infection that causes swelling of the larynx (vocal box) and trachea (windpipe) that in turn makes the airway just beneath the vocal cords become swollen and narrow. When you have swelling and narrowing of the airway breathing becomes more difficult and noisy and the sound that is made, almost like that of a seal barking, is called being “croupy”. Croup is quite common in young children, but the sound the emanates from that child when they cough, can be scary and concerning for both parent and child. Children are most likely to get croup between the ages of six months and three years. As a child gets older croup is not as common as the trachea gets larger with age and therefore the swelling does not cause as much compromise. When you awaken in the middle of the night to hear your child “barking” in the next room you need to know what to do. Most croup is caused by a common virus, so croup is not treated with antibiotics. The mainstay for the treatment of croup is try and calm you child, as they may be scared both from the tight feeling in their chest, as well as the sound that is made when they are breathing and coughing. The best treatment for croup seems to be taking your child into the bathroom and turning the shower on hot. Let the steam from the hot water fill the room and sit in there and read a book or two to your child. Typically within five to 10 minutes (before the hot water runs out) the moist hot air should help your child’s breathing. They may still have the barking, croupy cough, but they should be more comfortable and will not look like they are having trouble breathing. If the moist steam does not work, and it is a cool fall night, go outside. That is right, taking your “croupy” child from the moist heat in the bathroom, outside to cool night air may also help open their airways. If your child is showing signs of respiratory distress, with color change with coughing (turning blue while coughing, red is always good), is retracting (using their chest muscles between the ribs to help them breath), is grunting with each breath, or seems quite anxious and having trouble breathing you should call for emergency help. If a child is having real difficulty breathing they may be admitted to the hospital to have supplemental oxygen or breathing treatments. Steroids have also been helpful when used for the correct patient population. Steroids may be used in both an outpatient and inpatient setting. Steroids help to reduce inflammation in the trachea and the symptoms lessen over several days. Steroids used in a short burst are not harmful to your child, and are indicated in a child who may have mild respiratory distress due their croup symptoms. Your child may have symptoms of croup for several days, and for some reason they always seem to be worse at night. Put your child to bed with a cool mist humidifier in their room for the next several nights, this will also help to provide moisture to their airway. It is not uncommon for some children to seem more “prone to croup” and may get it recurrently all fall and winter. Have the humidifier handy and in working order! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Dealing with Warts

1.30 to read

Warts are one of the most common skin lesions seen in pediatric practices. Warts also drive parents and some kids crazy!  According to one study up to about 1/3 of school children have warts.  

Warts are viral infections of the skin which are caused by human papilloma viruses (HPV).  There are more than 100 types of HPV and different types of HPV cause different types of warts. The most common warts on hands and knees are caused by HPV types 1,4, 27, 57.  These are not the HPV types that cause sexually transmitted infections 

Some people seem to be more prone to getting warts than others, and it is not uncommon to see several children in one family dealing with warts. The HPV virus is spread through skin to skin contact or through contaminated objects or surfaces. In other words, they are hard to prevent.  HPV can also have a long incubation period, so when parents ask, “Where and when did my child get this wart virus?”, my answer is typically, “not even the CIA will be able to tell you that”.  

I many cases if the warts are left alone they may resolve on their own in months to years (one study showed two thirds remission in 2 years) ......but with that being said, most teens (especially girls) want those warts to “be gone!” 

There are several different ways to treat warts and one of the most effective is with over the counter (OTC) products that contain salicylic acid.  Salicylic acid acts as an irritant that activates an immune response against HPV.  There are tons of different OTC products and in many studies there was not one product that proved superiority over another, so I would buy an “on sale” salicylic acid for starters. I know from using these on my own children that you have to be consistent and persistent in their use....but it did work. 

If OTC products don’t seem to be working the next step for those who are determined to try and get rid of the wart,  is to head to the doctor who may try freezing the wart with liquid nitrogen or using cantharidin.  Unfortunately, there is typically a little pain involved with these products. 

Like so many other things, sometimes it may pay to just to wait it out and see if the virus just gives up and goes away!

Daily Dose

Skin Lesion: Staph or Pimple?

1:30 to read

I just received an email question from a teenager who happened to attach a picture of a skin lesion she was worried about. I think it is great that teens are being proactive about their health and are asking questions about issues that are concerning to them.  BRAVO!!

So, this “bump” sounds like it started out as a possible “zit” on this 16 year old girl’s neck.  She admitted to lots of “digging” into the lesion and then became concerned that it didn’t seem to be getting any better.  She said that friends told her that it could be scabies, or possibly staph.  Leave it to friends to make you more apprehensive about the mystery bump. Looking at the picture it looks like it could be a simple pimple and in that case the best medicine is to LEAVE IT ALONE. The hardest thing to get teens to do (and also adults) is not to pick at pimples or bumps on their bodies, as this could lead to a skin infection. Many times just washing the “zit” and leaving it alone, it will go away.  When you go “digging” into it you break the skin and allow bacteria to enter the now open wound and you can get a skin infection. 

In many cases this may be due to staph or strep from your hands.  This may sometimes require a topical or oral antibiotic to treat the infection, when it may have been something that should have been left alone. There are skin infections that we are seeing in the community that are due to MRSA (methicillin resistant staph) which have become quite frequent in the last several years. In this case that small “bump” usually arises quite quickly, often times it is confused with an insect bite. But very quickly the bump becomes more inflamed, tender and often quickly grows in size. Many times there will be drainage from the bump which now resembles a boil.  In my experience the hallmark of MRSA infections is how quickly they arise and how painful they are.  They have a fairly classic appearance (see old post on Staph).

MRSA infections often have to be drained and require different antibiotics than ”regular” skin infections. In most cases it is necessary to obtain a culture of the drainage so that the appropriate antibiotic may be selected. In some circumstances the infection is quite extensive and may even require surgical drainage and IV antibiotics, requiring a stay in the hospital.  MRSA is a serious infection and is often seen in teens who share articles of clothing or participate in sports where they are showering, using equipment etc that is shared. Remember to use your own towels, and athletic equipment when you can.

This teen also asked “if you have staph would you have it forever?” In actuality, many of us harbor staph in our noses and we all rub our noses throughout the day and then touch other parts of our body as well as other objects. This then passes the bacteria from person to person, sometimes via another object. If you are not symptomatic, don’t worry about whether you have staph in your nostrils, but do adhere to good hand washing and try to keep your hands away from your face. For patients who have had recurrent skin MRSA infections, I often prescribe an antibiotic cream to be put in the nostrils as well as in the nostrils of all close contacts (family members). I also recommend that the patient bath in an anti-bacterial soap and take a bleach bath every week to help decrease the bacterial colonization with staph. It seems that this has helped prevent reoccurrences of staph for the individual as well as for other family members. Lastly, this is certainly not scabies, but we have an older post on that too with pictures!

That’s your daily dose for today. We’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Easing Anxiety Over First Periods

I saw a number of “tweens” this week so that meant a lot of discussions about development, puberty and periods.

Once a girl begins her first periods, which typically occur around the age of 12 ½ years, it is not uncommon to have irregular menstrual cycles. I try to explain this to young girls before their periods start, so that they are not concerned if they have their first period and then worry if they don’t have another one in 28 days. A “normal” menstrual cycle occurs every 28 days +/- 7 days. In other words everyone is a little different and some women have 22-day cycles, while others may have 34-day cycles and these are both considered to be normal variations.  Not everyone is the same, so that is important to explain to a young girl, as they are comparing notes with friends all of the time. When a girl has her first period (menarche) she typically may not have regular cycles due to the fact that she does not ovulate regularly. Many menstrual cycles in the first two years are described as being anovulatory. This actually occurs anywhere from 55 to 85 percent of the time during those two years after menarche. Even after five years of menstruation, 20 percent of cycles may be anovulatory. All of this leads to the reason that young girls often have quite erratic cycles, and it really “bugs” them. Another interesting fact is that girls that begin their periods at a younger age have a shorter duration of anovulatory cycles, and may therefore be telling their 13-year-old friend “I have regular periods already, what is wrong with you?”  Again, you just need to understand that we are all different. The hormonal changes that occur with ovulation are different than those during an anovulatory cycle and that is why bleeding may be different and irregular. You need “mature” hormonal feedback to ultimately begin regular cycles. Other events in a woman’s life such as stress, lack of sleep, an illness or extreme weight loss may even effect menstrual cycles. Explaining all of the “nuances” of periods is important because many girls think they will get a period, and they will bleed every 28 days for many years. They really do get quite “freaked” out if things are different than they expected. Giving them a little anticipatory guidance seems to put them more at ease and will hopefully prevent anxiety, which may only mess up their periods a little more. Oh what a tangled web! That’s your daily dose, we’ll chat again tomorrow! Send your question to Dr. Sue!

Daily Dose

The Difference Between Cradle Cap And Dandruff

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I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two.

You know there really isn’t as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil). Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a “cosmetic” problem for a baby as it looks like a yellowish plaque on a baby’s scalp and is often not even noticed by anyone other than the parents. Unlike seborrheic dermatitis in adults, cradle cap typically doesn’t itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby. These hormones cause the sebaceous glands to become over active. In some severe cases an infant’s scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces. The treatment for cradle cap is to wash the baby’s scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby’s eyes). This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby’s head and let it sit (I left a small amount on my children’s heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily. For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant’s eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem. As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called “malessizia” so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works. I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don’t like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

How to Treat Poison Ivy

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With the vacation season 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 childhas come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

Daily Dose

Winter Season & Eczema

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I received these nice pictures and a question via email the other day. The mother was concerned as she had found this “spot” on her 6 year old son’s back. He was otherwise well and she did not see any other “spots” or rash.   

Her son complained that the “spot” was itchy so being the good mother she applied some over the counter cortisone cream for several days (which I always tell patients to try). After 2 days of it not improving, but not worsening, she thought it might be ringworm (also a good thought) and she applied an OTC anti-fungal cream.  Again, the rash was not better, but really not worsening or spreading.  That is an important part of the history. 

Now in medicine you learn about red herrings, which are part of a patient’s history that may not really have any bearing to their current problem....but one has to consider it. In this case, her dog developed a lesion and was taken to the vet and was diagnosed with a staph infection, but the vet told the mom that the dog was not contagious to humans.  Red herring or is that the problem? 

After looking at all of the pictures (which is never as good as seeing a rash in person), I am thinking that this may be nummular eczema, (nummular means coin shaped, hence the round)  The history is right as is was not bothersome other than being itchy, and eczema is often called the “itch that scratches”.   

With all of this cold dry weather and heaters on full blast all over the country eczema is having a heyday.  I have seen a ton of these little inflamed patches on skin of all ages (my own hands are a mess).   The treatment of choice is to moisturize the skin and also the use of a topical steroid. But, it takes a long time to see an improvement in the spots and they may change on a daily basis depending  on the weather, bathing and how much lubrication and moisturizing you are doing.  

I would use an OTC moisturizer that contains ceramides (Cetaphil Restoraderm, Cerave, Aveeno for eczema) and use it liberally and frequently.  I would also apply an OTC steroid several times a day (under the moisturizer). Eczema also sometimes requires a stronger topical steroid that is prescription. 

Hope that helps.....but if not improving after 7-10 days it may be worth a visit to your pedi for up close and personal diagnosis.

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

Kids Who Snore

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Does your child snore?  If so, have you discussed their snoring with your pediatrician.  A recent study published in Pediatrics supported the routine screening and tracking of snoring among preschoolers.  Pediatricians should routinely be inquiring about your child’s sleep habits, as well as any snoring that occurs on a regular basis, during your child’s routine visits.  

Snoring may be a sign of obstructive sleep apnea and/or sleep disordered breathing (SDB), and habitual snoring has been associated with both learning and behavioral problems in older children. But this study was the first to look at preschool children between the ages of 2-3 years.

The study looked at 249 children from birth until 3 years of age, and parents were asked report how often their child snored on a weekly basis at both 2 and 3 years of age.  Persistent snorers were defined as those children who snored more than 2x/week at both ages 2 and 3.  Persistent loud snoring occurred in 9% of the children who were studied.

The study then looked at behavior and as had been expected persistent snorers had significantly worse overall behavioral scores.  This was noted as hyperactivity, depression and attentional difficulties.  Motor development did not seem to be impacted by snoring.

So, intermittent snoring is  common in the 2 to 3 year old set and does not seem to be associated with any long term behavioral issues. It is quite common for a young child to snore during an upper respiratory illness as well .  But persistent snoring needs to be evaluated and may need to be treated with the removal of a child’s adenoids and tonsils.

If you are worried about snoring, talk to your doctor. More studies are being done on this subject as well, so stay tuned.

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If your child snores, is this a sign of something more serious?

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