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Daily Dose

The Difference Between Cradle Cap And Dandruff

1.15 to read

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

Summer Series: Best Ways To Use Bug Spray

1.00 to read

Now that you know all about the options for bugs sprays this summer, let’s discuss the guidelines for using these products.

The American Academy of Pediatrics (AAP) and the Environmental Protection Agency (EPA) have issued recommendations for the application of insect repellents in children. These include the following:

-Do not apply bug spray to children under 2 months of age

-Use up to 30% DEET in children, depending on duration of outdoor activities. Avoid the use of higher concentrations in children.

-Apply insect repellent only to exposed areas of skin and/or clothing. Do not use repellents under a child’s clothing.  Certain repellents may damage synthetics, leather or plastics.

-Do not apply insect repellent to eyes or mouth, and apply sparingly around the ears. Do not spray directly on the face, spray on your hands first and then apply to the child’s face

-Do not apply bug spray over cuts, eczema or breaks in the skin.

-Have a parent or caregiver apply the bug spray as a child may inadvertently ingest the spray.  Do not allow children to handle the repellents without supervision.

-Wash repellents off with soap and water at the end of the day. This is especially important when repellents are used repeatedly in a day or on consecutive days. Also wash treated clothing before wearing again.

-Combination products containing DEET and sunscreen are not recommended, as sunscreen should be reapplied frequently (every 2 hours) and in contrast bug repellents should be applies as infrequently as possible.  It is also thought that DEET may decrease the effectiveness of sunscreen.

-Do not use spray in enclosed areas or near food. Avoid breathing the repellent spray.

-There are other ways to beat the bugs too.  Try to avoid go outside when the bugs are most active, dawn and dusk.

-When your child does go out cover as much of the skin as you possibly can. Use lightweight, long sleeved clothing and pants.   Do not dress your child in bright colors or flowery clothing.  For young children use mosquito netting over their strollers etc.

-The use of citronella candles or bug zappers have not been shown to help .

-Eliminating standing water in yards and areas around the house and yard will help eliminate mosquito breeding. Fans do seem to help as mosquitoes have trouble maneuvering in the wind, so buying a fan to use around the picnic table may be useful. There are many ways to try and avoid the dreaded insect bites, the “battle” is just beginning.

So, gather information and your favorite repellents and enjoy the outdoors. That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue right now! Check the UV Index in your neighborhood here

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. 

Daily Dose

How To Treat A Cough

1.30 to read

It is FINALLY March which often is the last month that our pediatric office is inundated with illness. I can now honestly tell exhausted parents (and our nurses) that this could possibly be their child’s last cold of the 2013-2014 winter season. I would still keep my fingers crossed as well.

But, with that being said I still hear coughs throughout the exam rooms and the beeping of the pulse oximeter measuring a child’s oxygenation. These are sounds I rarely hear once we hit April-May.  Parents continue to be concerned about their child’s cough and parent’s and children alike are tired.... often due to sleep disruption due to coughing.  

While numerous remedies to suppress nightime cough have been tried, most of the studies done in children ( over 1 year of age) showed no benefit with either dextromethorphan (found in many OTC cough and cold preparations) or diphenhydramine (Benadryl).  On the other hand, there have been 3 randomized controlled trials showing the effectiveness of honey on reducing nighttime coughing brought on by an upper respiratory infection (also known as a cold.)

Honey has been used for a variety of medicinal uses for thousands of years, but like many other things (Power Rangers, Hello Kitty, Rocky and Bullwinkle), the use of honey is making a comeback!!  While different types of honey have been tried (the first study used Buckwheat honey, others have tried eucalyptus and citrus honey,) the type of honey used has not been found to be significant. There has yet to be a study done using the traditional clove honey we all have in our pantries.  

The mechanism for how the honey works to suppress the cough is still unclear. Some feel it is the antioxidant effect of honey, as well as its antimicrobial effects.  Others postulate that the sweet taste may  even reduce the central sensory nerves urge to cough.  Whatever the mechanism, most parents and children don’t care if they just can stop coughing at night!

Honey may safely be used in children OVER the age of 1 year.  The typical dose is 1/2 tsp for children between 1-5 years, 1 tsp for 6-11 years and 2 tsp for older children.

Give it a try on those last hacking coughs this month....spring is just around the corner.

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. 

Daily Dose

Teen Drivers

1.30 to read

As you know, when teens start to drive, I am a huge advocate for parent - teen driving contracts. I wrote my own contracts for my boys but I recently found a website that all parents who are getting ready to have teen drivers need to be aware of.

Injuries from motor vehicle crashes are the #1 cause of death for teens in the United States.  Studies have shown that having limits and boundaries in place for new drivers reduces the number of motor vehicle accidents that new drivers experience. Although not all states have “graduated driver’s licenses”, all parents can have discussions about the privilege and responsibility of driving and set their own guidelines for their new teen driver.

The website www.youngdriverparenting.org was developed by the National Institute of Child Health and Human Development and is an interactive site for both parent and teen.  The program is entitled “Checkpoints”.  The website includes teen driving statistics to help parents keep their teen drivers safe as well as giving information about state-specific teen driving laws.

The site has a great interactive component to help parents create their own parent-teen driving “contract” that addresses such things as teen driving hours, number of passengers allowed, and boundaries for driving. These parameters can be modified as the teen becomes more experienced and meets the “checkpoints” that were agreed to.  It is a great site as it not only gives you a template for the agreement, but sends emails as the allotted amount of time has passed for each step of the contract.  You don’t have to remember what you and your teen agreed to, they email you and then you and your child can revisit the agreement and expand it over time as your driver becomes more experienced.

Instead of handing out my “dog eared” old driving contracts that I wrote for my boys, I am now going to send my patients to this site (which is also being sustained by the American Academy of Pediatrics).  

Teen drivers whose parents are actively involved in monitoring their driving are not only less risky drivers but know ahead of time what their parent’s expectations are. Having a teen involved proactively with driving rules is far preferable to regretting that limits, boundaries and parental rules were not discussed prior to allowing your new driver on the road.

The website is not only free it is also evidence based, and within 5 - 10 minutes of reviewing the site a family is set to go with their own checkpoint agreement.  Here’s to teen driver safety!

Daily Dose

Good Grades Pill

1.15 to read

There is a lot of pressure placed on students to succeed and many of them are turning to what teens call the “good grade pill”.  What is it?  Prescription stimulants that are commonly used to treat children with ADHD.  Teens that have not been diagnosed with ADHD have figured out that with the help of these drugs, they can focus and improve their grades.  

I see a lot of kids who have attentional issues and I evaluate and treat children for ADHD. With that being said, I also spend a great deal of time with each family looking at their child’s history, report cards, teacher comments, educational testing and subjective ADHD rating scales. 

While many families would like it if I just “wrote a script for a stimulant”, I feel it is my job to try and determine to the best of my ability, which children really fit the diagnosis of ADHD. (There are specific criteria for diagnosing ADHD). 

But in the last 3-5 years I personally have seen more and more teenage patients coming to me with complaints of “having ADHD”. These are successful teens who are now in competitive schools. 

In most of the cases there have never been any previous complaints of difficulty with focusing or inattentiveness. All are typically A and B students but are now having to work harder to keep their grades up, and to also keep up all of their extracurricular activities. They too all want to go to “great colleges” and their parents expect that of them as well. 

When I see these teens, I point out to them that there has never been mention of school difficulties throughout their elementary and middle school years. I also tell them that ADHD symptoms by definition are typically evident by the time a child is 7 years of age, and often earlier.  So what do you do? I don’t take out the script pad. 

I believe that stimulant medications are useful when used appropriately.  I am also well aware that these drugs are overprescribed and are also being abused. I have had parents (and teens) be quite upset with me when I decline to write a script for stimulant medication for their teen.  

I think that this problem is growing and (we) parents need to stop pressuring our children and (we) doctors need to be vigilant in deciding when stimulant medications are appropriate. 

It is a slippery slope, but the number of teens obtaining stimulants illegally is on the rise.  Why? They hear that this is a quick fix to getting good grades. It may help their grades for the short term, but what does their long term future look like? 

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

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

When Parents Date

1.30 to read

I recently saw some patients of mine who are now teens. They were brought in for their check ups by their father who i had not seen in some time.  He has a boy and a girl about 16 and 14 years old.  I knew that there had been some “issues” within their family, but is had actually been several years since i had seen them.

As it turns out the parents had divorced, the mother had some problems with addiction and the father now had custody of the children. He was trying to get “everything back on track”, including visits to the pediatrician.  

After seeing each of the kids alone and talking to them, they actually seemed to be doing extremely well. They had seen a counselor during some of the more tumultuous times and were happy to be in a “stable” environment and had “less family stress” as they put it. They were both doing well in school, had lots of friends and were involved in different sports and school activities.  They said that their sad had been instrumental in getting things “back to normal”, or back to a “new normal”.  

I also visited with the dad and he told me he had a new concern.  He was really happy about how well his children were doing, all good.   It seems that he had just started dating agiain, and he was not quite sure how to handle the subject with his kids.  He told me that he had had several dates and his kids wanted to know....what’s next?

I had to laugh a bit, as we had just discussed his children dating.  My response was, “be honest with them”.  If you asked your teen after 2 dates “where is this going?”, they would probably reply, “dad, who knows, we’ve only had 2 dates...I’m not getting married!”.

I told him I would tell his children the same thing,  in a manner of speaking. I would acknowledge that I was enjoying dating, that I had no plans to get married any time soon, and did not even know if i was ready to be “exclusive” ( is that the adult version of Facebook official?) with anyone at this point.  

I would also make it clear that I would keep them updated if and when things changed, but in the meantime they did not need to worry. Their dad would be there everyday to get their breakfast, have dinner with them and continue their “new normal”. It was just such a good feeling seeing all of them happy!

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