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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

Plants That Cause Summer Rashes

1:15 to read

Now that summer is upon us and everyone is enjoying being outside I am seeing patients with contact dermatitis (rashes) after coming into contact with poisonous plants.  While allergies are slowing down a bit with the hotter weather, plants like poison ivy, oak and sumac (depending where you live) are full of leaves.  About 50% of people who come into contact with the leaves of these plants will have a reaction.

The adage “leaves of three, let them be” continues to be the best way to prevent getting a rash. That also means wearing long sleeves, and pants...and gloves. But what child goes off to play in the yard, or by the creek dressed like that for summer?  Sunscreen yes, gloves, probably not. 

If you realize you have been exposed to the plant leaves and therefore the urushiol (oil on leaf) , wash all areas of exposed skin as soon as possible with some products that are available like Tecru, Sanfel and Goop Hand Cleaner....if you don’t have those use dish washing soap.  

It may take up to 4 days after exposure to develop the rash and lesions may also appear at different times depending on the location and length of exposure to the urushiol.  The rash is usually really itchy and is often is linear clusters or little vesicles or blisters.  The rash does not spread by scratching or from the fluid inside the blisters, that is a myth. You cannot give anyone else poison ivy if you have washed off the urushiol.  

The best treatments relieve the itching and irritation.  Keeps nails short and hands clean so that scratching will not cause a secondary bacterial infection.  You can use oatmeal baths (Aveeno) or cool compresses (Dommeboro) to help control itching. An over the counter steroid cream is a good place to start to help the inflammation, but it may be a stronger prescription steroid cream will be needed. 

I also try calamine lotion or astringent to soothe the irritation. Sarna is another good lotion for itching....Oral antihistamines like diphenhydramine (Benadryl) really don’t help with the itching as it is not due to histamines, but may cause a bit of sedation so a child can sleep.

If the rash is getting worse, spreading to the face and around the eyes or begins to look infected it is time for a visit to the pediatrician. For severe cases oral steroids may be necessary.

It sometimes takes 10-14 days for the rash to go away.  Oh, and getting overheated only makes you itch more.

Your Child

Protect Against Heat-Related Illness and Dehydration

2:00

Think it’s hot where you are? Try spending a few minutes outside in the southwest part of the country. This year, several cities have already set records of the longest stretch of time with temperatures 115 degrees and higher, and we’re only half way through the summer.

Your family’s area may not be experiencing those kinds of extreme temperatures, but it doesn’t have to be that hot for a child to end up with a heat-related illness or dehydration when out of doors.

Kids are particularly vulnerable because a child's body surface area makes up a much greater proportion of his overall weight than an adult's, which means children face a much greater risk of dehydration and heat-related illness.

Longer daylight hours often means kids spend more time in the sun so it’s important to make sure your child doesn’t become dehydrated or over-heated.

The early signs of dehydration can include fatigue, thirst, dry lips and tongue, lack of energy, and feeling overheated. But if kids wait to drink until they feel thirsty, they're already dehydrated. Thirst doesn't really kick in until a child has lost 2% of his or her body weight as sweat.

Dehydration can cause three of the worse types of heat-related illnesses:

Heat cramps: Painful cramps of the abdominal muscles, arms or legs.

Heat Exhaustion: Dizziness, nausea, vomiting, headaches, weakness, muscle pain and sometimes unconsciousness.

Heat stroke: A child with heat stroke can have a temperature of 104 degrees or higher. Severe symptoms such as nausea and vomiting, seizures and disorientation or delirium can occur as well as a lack of sweating, shortness of breath, unconsciousness and even coma.

Any one of these heat-related illnesses requires immediate medical attention.

To prevent dehydration make sure your child drinks plenty of cool water and often. They should be hydrated before play and during – even if they tell you they are not thirsty. A good size drink for a child, according to the American Academy of Pediatrics, is 5 ounces of cold tap water for a child weighing 88 pounds, and nine ounces for a teen weighing 132 pounds. One ounce is about two kid-size gulps.

Dehydration can be a tricky thing to catch early. It is typically cumulative – meaning that it may take several days to reach a dangerous point.  If your child is 1% or 2% dehydrated on Monday and doesn't drink enough fluids that night, then gets 1% or 2% dehydrated again on Tuesday, that means your child is 3% or 4% dehydrated at the end of the day. "They may be gradually developing a problem, but it won't show up for several days," says Albert C. Hergenroeder, professor of pediatrics at Baylor College of Medicine and chief of the sports medicine clinic at Texas Children's Hospital.

One way to monitor your child’s hydration is to weigh him or her before and after a sport’s practice or game or playing outside. If his weight drops, he's not drinking enough during his workout.

A simple rule of thumb: if your child's urine is dark in color, rather than clear or light yellow, he or she may be becoming dehydrated.

If you suspect your child is getting over-heated, get him or her out of the sun and into a cooler place. Have the child start drinking plenty of cool fluids. The child should also take off any excess layers of clothing or bulky equipment. You can put cool, wet cloths on overheated skin. In cases of heat cramps, gentle stretches to the affected muscle should relieve the pain.

Kids with heat exhaustion should be treated in the same way but should not be allowed back on the field the same day. Monitor your child even more carefully, Hergenroeder says.

If your child doesn't improve, or can't take fluids, see a doctor.

Some children are going to be more prone to heat-related illness. The biggest risk is a previous episode of dehydration or heat illness. Other factors that can put your child at greater risk for heat illness include obesity, recent illness (especially if the child has been vomiting or has had diarrhea), and use of antihistamines or diuretics.

If a child has been indoors most of the summer, they may not have had a chance to adjust to the hotter weather. Kids should add a little more time out of doors each day until they acclimate to the heat. However, with some of the high temperatures we’re having, it’s best to schedule activities in the morning. It can still be 90 degrees with a humidity index of 107 at 9:00 pm in some places.

In a smart move, a growing number of athletic programs suggest that it is sometimes too hot to practice. In fact, many are restricting outdoors practice when the National Weather Service's heat index rises above a certain temperature. The heat index, measured in degrees Fahrenheit, is an accurate measure of how hot it really feels when the relative humidity is added to the actual temperature.

Kids need time out of doors and certainly time to play and have adventures. Parents can help keep their children from experiencing heat-related illnesses by making sure their child is hydrated and not spending too much time out of doors when the temperature or humidity index is high.

Story source: Roy Benaroch ,MD, http://www.webmd.com/children/dehydration-heat-illness#1

 

Daily Dose

Treating Sunburn

1.15 to read

Is it hot enough for you and your kids?  I bet every day you look at the weather map and try to figure out the best ways to beat the heat. 

With kids taking the plunge to stay cool, many forget to re-apply sunscreen and end up with a bad sunburn.  Sunburn is no fun and can cause significant problems. 

Sunburns may cause first-degree burns and you know it when you see it…your child’s skin turns pink and red and is uncomfortable, and itchy. 

Sunburn may also cause second-degree burns where the burn actually penetrates the dermis and causes blistering and a deeper burn and more cell damage. With blistering may come scarring and also an increased risk of skin cancer and skin damage later in their lifetime. 

Repetitive sunburns are cumulative and can put your child at even more risk for melanoma. Recurrent sunburns are often seen on the nose, ears, chest, and shoulders. 

You may not notice symptoms until 2-4 hours after the damage has begun. You’ll see redness over the next 12 -24 hours with pain, swelling and blistering. Some children will even develop nausea, fever, vomiting or dizziness after a significant sunburn and are at risk for dehydration. 

The best way to treat sunburn begins by moisturizing the burned area to cool down the skin and reduce inflammation. Try a cool bath or apply cool, wet cloths.  I like a product called Domeboro.  It’s very soothing when added to a bath or to cloths that you can soak in the solution. 

Keep your kids hydrated to replace fluids.  You can also give your child a pain reliever like Tylenol or Motrin/Advil to help with discomfort.  Some children also respond to an oral antihistamine to help with itching. 

Do NOT let your child back in the sun until their symptoms are improved and even then they should wear sun protective clothing as well as sunscreen. Remember, you can even get a burn in the shade, under an umbrella or on a cloudy day. Most of us heard that from our own mother's but unfortunately did not believe it until we ourselves had experienced a sunburn.

 

 

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Daily Dose

Dry Drowning

1:30 to read

It seems that at least once a week this summer I have seen a child in my office with a concern of “dry drowning”. In each case the child (anywhere from 2-6 years old) has been swimming and has had not had any issues…just a fun day in the pool.  But, the following day they “seemed tired, and didn’t want to play”, but were content to watch cartoons or play video games. A few of the children I have seen were sitting on my exam table eating a lollipop and playing on their mother’s I-phones.Thankfully, none were having any difficulty with breathing!

 

So…their concerned parents have seen media reports and are worried that this “fatigue and lethargy” is the presentation of “dry drowning”. In most cases they have also searched “dry drowning” on the internet and the first thing they see is WebMD’s definition of “dry drowning” which would concern most parents!  The article at the top of the Google search includes this.. “putting your child to bed after swimming and they never wake up in the morning”???  Who wouldn’t be worried….

 

But, if you ask most doctors (certainly all of the ones I know) they do not understand what “dry drowning” is, and have never seen a case like the one described by WebMD.  This small survey of mine included pediatric ER docs as well.  Actually “dry drowning” is not even mentioned in pediatric textbooks, and it is difficult to find the term in medical literature when doing a journal search. It is more likely to be found in media articles. 

 

As I understand it, the term “dry drowning” was first discussed in animal studies from years ago, in which animals died after ingesting water and experiencing laryngospasm, and it occurred 1-2 minutes after the immersion in water. None of the articles discussed “dry drowning” in children….but articles did discuss drownings!

 

In a pediatric study looking at data from over 15 years and “immersion related deaths- drownings” it was found that most drownings occurred at home and over 90% were due to lack of supervision.  There were no deaths reported from “dry drowning”. 

 

I am not concerned about any of my patients and “dry drowning”, but I am concerned about drowning!! 

 

Take home message….take your children to swim but be vigilant in watching them…..and you will not need to worry about any immersions or drownings!!  Drowning is preventable. 

 

 

 

 

 

 

 

Daily Dose

Sun Smarts

1:15 to read

School is out for most children and that means more time outside at the park, pool, beach or lake.  This also means that children and adolescents need to be using sunscreen on a regular basis.  Although the data does show that most parents are aware of the need to have their children use sunscreen, once a child is older and independent are they using sunscreen and if so appropriately?

There have been many studies that show that even adults do not apply enough sunscreen when getting ready for sun exposure.  In fact, children are also “stingy” when applying sunscreen.  A study done on school aged children who were given sunscreen (in different types of dispensers) to apply on their own before going out to play, showed that most kids did not apply the recommended amount for protection. It did seem that children who used a pump sunscreen dispenser applied more as compared to a roll-on or squeeze bottle.  

In another study done on children in early adolescence, at least 50% of those questioned admitted to having experienced a sunburn before age 11.   It also seemed that as children became older and in the teen years they reported using sunscreen less frequently than they had at earlier ages.  The teens admitted to “liking a tan” and to “spending time outside to get a tan”. 

With the incidence of melanoma on the rise and the knowledge that there is a correlation between sun exposure/burn and melanoma, teaching our children how to use sunscreen properly and how to avoid sunburns is critical.  As my dermatologist friend likes to say, “sun behaviors are an important part of parenting”.  I would tell you, all of her children are “well behaved “ and have beautiful skin as well!!

Daily Dose

Treating Sunburn

1.15 to read

Is it hot enough for you and your kids?  I bet every day you look at the weather map and try to figure out the best ways to beat the heat. 

With kids taking the plunge to stay cool, many forget to re-apply sunscreen and end up with a bad sunburn.  Sunburn is no fun and can cause significant problems. 

Sunburns may cause first-degree burns and you know it when you see it…your child’s skin turns pink and red and is uncomfortable, and itchy. 

Sunburn may also cause second-degree burns where the burn actually penetrates the dermis and causes blistering and a deeper burn and more cell damage. With blistering may come scarring and also an increased risk of skin cancer and skin damage later in their lifetime. 

Repetitive sunburns are cumulative and can put your child at even more risk for melanoma. Recurrent sunburns are often seen on the nose, ears, chest, and shoulders. 

You may not notice symptoms until 2-4 hours after the damage has begun. You’ll see redness over the next 12 -24 hours with pain, swelling and blistering. Some children will even develop nausea, fever, vomiting or dizziness after a significant sunburn and are at risk for dehydration. 

The best way to treat sunburn begins by moisturizing the burned area to cool down the skin and reduce inflammation. Try a cool bath or apply cool, wet cloths.  I like a product called Domeboro.  It’s very soothing when added to a bath or to cloths that you can soak in the solution. 

Keep your kids hydrated to replace fluids.  You can also give your child a pain reliever like Tylenol or Motrin/Advil to help with discomfort.  Some children also respond to an oral antihistamine to help with itching. 

Do NOT let your child back in the sun until their symptoms are improved and even then they should wear sun protective clothing as well as sunscreen. Remember, you can even get a burn in the shade, under an umbrella or on a cloudy day. Most of us heard that from our own mother's but unfortunately did not believe it until we ourselves had experienced a sunburn.

 

 

 

 

 

Daily Dose

Summer Slide

1:30 to read

School is out for everyone and that means lots of “down time “ for school children - all ages. I think that summer is really an important time for kids to get bored a bit.  In other words, fewer schedules, less connected to electronics, more play time and less stress….hopefully for all. I do know that as a working parent, I don’t think summer was as “unstressful” for me as it was for my children…as I had to continue to make sure that they had good child care and supervision - always challenging at times, but it all worked out and I would try to schedule a bit more time for me to be available for some fun outings.  

But, with fewer schedules and more time to “hang out” some children do experience what is referred to as “the summer slide”.  This can be defined as “the loss of academic skills over the summer break”. When children don’t read, work on math problems, or are not engaged in some sort of learning activity their skills and knowledge over the course of a 2-3 month summer vacation may regress. There is data to show that the loss in learning does vary with grade level,  subject matter and socioeconomic status - but most children show some negative changes when they are tested at the beginning of the summer vacation as compared to the end of the summer.  

The best way to try and prevent the summer slide is to have an idea or plan on how to keep your children interested in learning….but by doing different things than one might do during the school year.  

How about a summer book club or reading program that you might find either on line or through your public library.  There are book lists and fun reading projects for all ages…and if your child is older you might join them in reading one of the classics or even a new novel and discussing it together.  Even if your child claims to “not like to read” these programs are fun and reading a sports book or a scifi adventure may spark their reading.

Field trips:  Whether you live in the city or suburbs or even the country there are many FREE places to visit in your community. That might be a simple trip to the park to play while at the same time talking about why we have parks, and green spaces.  Museums typically have programs for children of all ages …and many are interactive with the parents. It is amazing how much “new” stuff there is to learn, for all of us.  If you are fortunate to live in driving distance to a national park or seashore take advantage of the many free events there. 

Mass transit: I know that when we finally got light rail in Dallas I took the opportunity to ride the rail with our young boys….all sorts of learning taking place as we read signs, and learned how to read a map of the rail system.   We also saw some local sites that we had never taken advantage of.  Inexpensive way to spend a day and the subway, light rail and bus systems in some areas are really growing.

This is also a good time of year to teach your children a few of the “basics”…whether that is how to pump a swing, or ride a bike with or without training wheels, how to tie their shoes, wash the car, or catch a ball …lots of life skills that may get ignored during the school year, and these are skills everyone should know. 

 

 

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