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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

Does Your Child Have A Crooked Finger?

What Can You Do For A Crooked Finger?I received an email via our iPhone App from a mom who was worried that her daughter had a “crooked” finger.  She did not give any more specifics, but the most common finding in children is a curvature of the 5th or “pinky” finger called clinodactyly.

The word clinodactyly is derived from the Greek words kliner “ to bend” and dactylos, “a finger”.  Clinodactyly is typically caused by abnormal growth and development of the small bones of the finger resulting in the curvature of the finger in the same plane as the palm.

Clinodactyly may occur in up to 10% of the population, but occurs to different degrees.  It is typically a benign condition but has been associated with numerous syndromes where it occurs in combination with other abnormalities. There are several common characteristics seen with clinodactyly. It  is more common in males and is often bilateral (occurs on both hands). It is frequently seen in families as an inherited “condition” and is thought to be autosomal dominant,  so when you go to a family reunion look at everyone’s fingers as you probably have a lot of siblings or cousins who have the same bent finger. When clinodactyly is minimal and does not cause any problem the best treatment is simply watchful waiting.  If the “deformity” becomes progressive as a child grows, then xrays may be obtained to further delineate the abnormality and surgical treatment may be undertaken.  A board certified hand surgeon would be the preferred choice to do this surgery. Send your question to Dr. Sue!

Daily Dose

Belly Button Care

1:15 to read

Belly buttons seem to make new parents a bit crazy.  Once the “lifeline” from mother to child is clamped in the delivery room, the umbilical cord really serves no further purpose...other than to cause a lot of anxiety and annoyance for new parents.

I get many questions concerning “how to fold the diaper” and “not rub the cord” or “what if I got a little water on the cord when I gave the baby a sponge bath?”.  I had a text today saying, “the cord is dripping a bit of blood, did we do something to it?” 

It typically takes anywhere from 5-14 days for the cord to fall off. During that time it typically just “sits” there...and dries up. Some hospitals still apply gentian violet to the umbilical cord and others now just leave it alone and let it dry.  Either way....your job is to try to ignore the cord and just let it fall off.

As the cord dries up and it detaches it may bleed a bit...remember the umbilical stump is like a scab.  It is not uncommon to see if few drops of blood or dried blood on the edge of the diaper.  As the cord detaches even more there may be a part that oozes a bit as well....but don’t be concerned, just like a skinned knee your child will have one day...the scab will heal with a bit of time and TLC.

Once the cord falls off you can now give your baby a bath...no more sponge bathing. And don’t worry if the belly button is a bit of an “outy, as it will often change over time unless there is an umbilical hernia...which is yet another discussion.

Daily Dose

Common Newborn Questions Answered!

Dr. Sue answers common questions about newborn babies.Well, it seems like it takes more than one column to discuss the first days home with a newborn baby.  After discussing the nuances of breast feeding, there are also many questions regarding all of the noises that babies make.

Everyone thinks that infants are pretty quiet, that is until you sleep with a newborn in the bassinet right next to your bed.  Newborns are noisy!!  They not only cry (that is a whole other topic) but they squeak, grunt, stretch, yawn, have weird breathing noises, hiccup and pass tons of gas. (Dad’s are so cute when they say, “there is something wrong with my baby girl as she FARTS and it stinks, this can’t be normal?”) The first thing that many parents will notice is that their infant has “weird” breathing patterns. The baby seems to take some rapid breaths and then pauses and it looks like “they have stopped breathing” for a few seconds, and then resumes their more normal breathing.   This is called periodic breathing and is quite normal for the first few weeks of a baby’s life.  I swear only first time parents notice this, as you have the time to watch your precious baby and count their breaths. Every subsequent baby in the family is equally loved, but is typically not under the microscope like a first born and we only notice that they are ‘’’breathing”.  As an infant matures so does the breathing pattern and the respiratory rate becomes more rhythmic. If your baby has any color changes, i.e  turns dusky, or blue with their breathing that is a cause for immediate concern and a call to the doctor or 911. Another common concern is often how many times a day a baby will hiccup. If you remember, the baby often hiccupped in utero, and this too continues after they are born. Babies seem to hiccup for an inordinate amount of time, which bothers parents, but usually seems not to faze the baby at all. It is fine to try and give your newborn water if they are hiccupping and it is really bothering either you or them, but is not necessary.  Just like an infant’s startle (Moro) reflex, babies seem to get the hiccups when they are younger and they slow down as the baby’s nervous system matures.  A baby may hiccup for minutes to an hour and then just stop and fall asleep, oblivious to the concern that this event has caused their parents. Babies also make a lot of stretching and grunting and groaning noises, and are perfectly comfortable.  But these noises will awaken a sleeping parent.  If your baby is not crying during all of these noises, I would not pick he/she up, but would wait to see if they then go back to sleep. Some of these noises occur even while a baby is sound asleep. In this case the adage, “never wake a sleeping baby” is good advice.  These noises do not necessarily mean a baby needs to eat, especially if you think they may have just eaten an hour ago. Again, your baby should not appear in any distress or have color changes, they are just noisy! Lastly, GAS!  All babies have gas, and no one knows that until they have cared for a newborn.  It does not matter if a baby is breast or bottle fed, they produce gas, and it is loud and may be stinky. I think that infants produce more gas in the first 3-4 months of life than they will again until they are old (grandparents age, ask them). It seems like so many things occur both early and later in life, and gas is just one example. As a newborn’s GI tract matures, they seem to produce less gas, and are also often more comfortable after a feeding. When a baby is “gassy” they often like to have movement, so they like to be rocked, or put on their tummy and patted (only if awake, never to sleep), and they may enjoy the swing, or the motion of riding in a car, or putting the infant seat on top or a vibrating washing machine or dryer.  There are many “home remedies” but maturation of the GI tract just takes time. In most cases, changing an infant’s formula or a mother’s diet will not change the gas, but many people will try it. Remember, this too shall pass! 
(no pun intended) That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

HPV Vaccine

1:30 to read

I recently read an interesting article in JAMA in which a study was done suggesting that “HPV vaccine does not lead to risky behaviors in teen girls”. This seemed to be a timely study as Merck has just recently received FDA approval for their new Gardasil vaccine which will now protect against 9 serotypes of HPV (human papilloma virus) which causes the majority of cervical cancer ( as well as other genital cancers) and genital warts.

Since the vaccines against HPV were released in this country about 8-9 years ago, the uptake of the vaccine among tween/teen girls and boys has been less than hoped for.  Like many vaccines, there were those parents who were “worried or skeptical” about giving their children a new vaccine - despite the fact that it is the first vaccine against a virus that was known to cause cancer..actually a great deal of cancers.  The CDC reports that about 57% of preteen/teen girls have received one dose of HPV vaccine, while only 35% of boys in the same age group. The completion rate for completing all 3 vaccines is only 37% for girls and 14% for boys. 

But while many parents believe in the benefit of the vaccine a common concern has been, “giving the vaccine to a pre-teen may lead girls to engage in sexual activity at younger ages”.  In my personal experience I have not found that to be at all true. In fact, educating these tweens and teens about the risk of infection and cancer is “scary enough” for some to be even more wary.  I am pretty direct with this group as they get into their true teen years and are experimenting in all sorts of ways...not only sexually. I truly do not think that a vaccine does “promotes” becoming sexually active....hormones do a good job in that area. 

So, the study looked at 21,000 vaccinated girls who were matched with more than 186,000 non vaccinated girls. Researchers then compared rates of sexually transmitted infections (STI) including herpes, chlamydia, gonorrhea, syphilis and HIV. They found that the “rate of STI’s overall were equal among the vaccinated and unvaccinated groups”, which suggests that the HPV vaccine does not impact sexual behaviors. 

With an even more protective HPV vaccine now available I encourage you to read the literature and talk to your own doctor about getting your adolescent vaccinated.  The vaccine is protective but does not treat HPV if you have already been exposed....there will be 14 million new cases of HPV in the U.S. this year...and that statistic is not one you want your adolescent to be among.

Daily Dose

Dog Bites

1:30 to read

I am a dog lover and we have always had a dog in our house….even before we had our children.  But, some dogs will bite and unfortunately there are more than 800,000 people every year who receive medical care for a dog bite…more than half of these are children.

 

Children are also more likely to be severely injured from a dog bite…and I was reminded of this today when I saw a very serious dog bite to a child’s face.  The child was brought to my office by his nanny after being bitten on his cheek by the family’s dog.  It was one of the worst bites I have ever seen! He was severely injured and should have actually gone straight to the ER….the good news is that he will ok, but he had to undergo surgery to repair the bite and will probably require another small surgery at some later date. 

 

In this case as in most, the dog bite occurs when a child is interacting with a familiar dog, and in this case it was the family pet. The little boy is a toddler with a twin sister and they were playing when he was bitten.  The dog had been around the children since they were born…and it is unclear what precipitated the bite.  Sometimes a dog becomes aggressive if they are bothered while they are eating or sleeping…and you know toddlers, they can “bother” anyone. 

 

One of my “boys” is also a dog bite statistic.  He was raised with dogs (my sweet lab Maggie is at my feet as I am writing), so I was totally caught off guard one night when the phone rang. My son had been spending the night at a friend’s house (he was about 10 years old) and the voice on the other end of the phone was the father of the friend (he too a doctor), informing me that my child had been bitten by their dog.  It seemed the boys were laying on the floor on blankets watching a movie and eating popcorn and for some “unknown “ reason the dog bit my son on his face.  The bite was not precipitated by anything…they had not been playing or rough housing with the dog and the dog had not been known to be aggressive. The next words out of the father’s mouth…”do you know a good plastic surgeon?” Not words you want to hear from another physician.

 

Thankfully, I did know a good plastic surgeon who I awakened after his long day in the OR….and he got out of bed and met us to suture my son’s face with over 20 stitches. Luckily it only involved his nose, cheek and chin, just barely missing his left eye. I am sure I cried more than my son.  He still has a scar across his nose..which only bothers his mother.  Incredibly, he never “blamed” their dog, went back to play at their house, and still loves his own dogs more than anything.  My brother who is a vet still thinks that any dog that bites without provocation should not stay in the home with children…but that is one vet’s opinion. 

 

It is especially important to teach your children never to approach a dog to pet it without first asking the owner if it is okay.  Children should learn to move slowly and let the dog “sniff” them first and to stay away from their face and tail. Teach your child how to gently pet an animal and to always be gentle.  If they are around a dog who is behaving in a threatening manner by growling or barking, they should slowly back away from the dog and try to avoid eye contact with the dog. If they are ever knocked over by a dog they should curl up in and ball and protect their face with their arms.

If your child is bitten and it is superficial it will probably just require care with soap and water. For bites that break the skin you should check in with your pediatrician.  Make sure you know the rabies vaccination status of the dog that bit.  You also need to make sure that your child is up to date on their tetanus vaccination. In some cases your child may also need an antibiotic.

Daily Dose

Baby Naming in the Hospital

1:15 to read

An interesting article was published this week in Pediatrics. If you have had a baby or visited the newborn nursery you typically see that a newborn is named “Babygirl or Babyboy Smith” on their crib and chart.  These are the temporary names given until the baby is named and the birth certificate is filled out. Well, it seems that these temporary names can cause quite a bit of confusion and may also contribute to medical errors, especially when there are babies with the same last name.   

These temporary names are even more problematic when a newborn is admitted to the neonatal intensive care unit (NICU), which was the case for my grand daughter last summer. While there may be few orders in the regular newborn nursery which are used for every baby, in the NICU each baby has many different orders and issues.  

A study was done looking at ways to cut down on medical errors in orders written in the NICU by using more distinct temporary names for newborns. In the study they incorporated using a mother’s first name into the newborn’s first name (for example, Susansgirl Smith). By changing the manner in which temporary names were used there was a 36% reduction in orders being placed in the wrong chart and then having to be retracted.

So, the next time you head to the NICU or newborn nursery for a visit you may soon notice a difference in the way temporary names are used. I can see how this would really make a difference as we often have several newborns in the nursery with the same last names and it can be confusing, even when the chart is labelled “name alert”. I like this idea and I would think it would be easy to implement this change without needing a lot of new training or computer programs.  We will all just get used to seeing longer temporary names on those baby cribs!

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

Don't Fear A Fever

1.30 to read

Fever......I talk about it every day, even in the summer months, but during the winter I sound like a skip on a CD explaining the “facts that we know” about fever.There are so many falsehoods surrounding fever, and many have been passed around for years. 

To begin with, FEVER is simply a symptom, it is not a disease.  We pediatricians define a fever as greater than 100.4 degrees Fahrenheit.  Now I know many people say, “but my child’s body temperature runs lower than 98.6, therefore they have a fever when their body temperature is 99.8 degrees.”.  What about, “my thermometer must be off because my child felt hot and the thermometer only read 99.9 degrees.”  Yes, these are often heard statements by parents in my office, who are convinced that their child has a fever, even when they don’t.  That is not to say that you might not feel great when you have a cold and your body temp is 99.8, but you don’t really have a fever.

Fever frightens parents, especially with young children and over the course of parenting most of us figure out that fever is not “scary”.  I sometimes say “look at fever as your friend”  as this means that your child’s immune system is working.  When you are sick and all of those white cells go to work, they  release all of their “disease fighting chemicals”  which ramps up the body to fight the infection and fever develops.  See, it is just a symptom of many different things going on within our body when we are sick.  Other symptoms, especially at this time of year include, cough, congestion, sore throats, vomiting, diarrhea. What really stinks is when your child has ALL of these symptoms at one time.....they just feel yucky!

Another myth, fever causes brain damage and that “the higher the fever the greater chance of brain damage”. This is NOT true.  High fever usually makes your child feel worse, but their brains are just fine. Yes, febrile seizures do sometimes occur (my own son had them), but even a febrile seizure does not cause brain damage.  Febrile seizures are scary for a parent to watch, but they may occur with any degree of fever. That is to say  a seizure may occur with a fever of 101 degrees or 104 degrees, doesn’t really make a difference.  A febrile seizure does not necessarily mean your child is any sicker than another child who does not have a seizure with their fever.  I know sounds crazy, but very true.

This is just the first part of the fever story.....more fever facts to come this week.

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Do antacids work for babies?

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