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

A News Alert for a Preventable Disease

There was a news release in the past several day alerting physicians to five cases of invasive H. Flu bacterial infections in children under the age of five in Minnesota during 2008. The reason this is significant is that this is a vaccine preventable infection. In other words, children are vaccinated against this bacterial infection beginning at two months of age. This is also a series of vaccines with infants receiving a series and a booster dose during toddler years.

There are several issues regarding this newsworthy information of an infection that was dramatically reduced after vaccination began in the early 90s. Number one, there has been a shortage of H. Flu (HIB) vaccine for the past year and infants are receiving the initial series, but doctors are withholding the booster dose in order to ensure adequate vaccine supplies for infants. At the present, it does not seem as if this is affecting vaccine efficacy but the Centers for Disease Control and Prevention (CDC) and state heath departments are watching for changes in rates of H. Flu disease which might indicate that the bacteria is having a resurgence as vaccines are delayed. Secondly, in looking at the five cases in Minnesota (the last time there were this many cases was more than 10 years ago), three of the children had not received HIB vaccine as their parent's refused vaccinations for their children. Of these three children, ranging in age from seven months to five years, all had invasive disease such as meningitis and pneumonia, and unfortunately one child died. I was a much younger pediatrician when I used to see these infections and yes, I too saw children die, or have long-term consequences such a being deaf or mentally retarded due to H. Flu infections. The HIB vaccine changed this and I have not seen a case in over 15 years, which is about the time the vaccine was released. This is a lesson in how vaccines work, not only for the vaccinated child, but also for the "herd" around them. Make sure your child has received this very important vaccine, so that we will not see more articles about increasing H. flu infections and preventable deaths. That's your daily dose, we'll chat again tomorrow.

Daily Dose

"White Noise" and Babies

1.00 to read

I received an email from Meredith (via our iPhone app) because she had heard that “white noise” might cause a child to have speech/language delays. She used a sound machine in her children’s rooms at night, and was concerned about the possibility of “interfering with their speech”.

So, I did a little research and found an article from the journal Science in 2003.  A study from the University of CA at San Francisco (UCSF) actually looked at baby rats who listened to “white noise” for prolonged periods of time. The researchers found that the part of the auditory cortex (in rats) that is responsible for hearing, did not develop properly after listening to the “white noise”.   

Interestingly, when the “white noise” was taken away, the brain resumed normal development. Again, this study was in baby rats, and to my knowledge has not been duplicated.  But, these baby rats were exposed to hours on end of  "white noise” which may not be the same thing as sleeping with a “sound machine” at night. 

We might need to be more concerned about background “white noise”. We do know that babies learn language by listening and absorbing human speech. They need to hear their parent’s talking to them from the time they are born.  They listen to not only their parent’s speech, but also to siblings, grandparents etc. and from an early age respond to that language by making cooing sounds themselves, often imitating the sounds they have heard. They are also exposed to a great deal of “white noise” or background noise with the televisions being on, computers, telephones, vacuum cleaners, lawn mowers etc. going on all day.  The “white noise” that may be reduced by turning off televisions, videos, computers etc and replacing that background noise with human speech through reading, singing and just talking to your baby and child could only be beneficial. One might surmise that “white noise” in the form of a sound machine at night would not affect a child’s speech development, as this is not a time for language acquisition.

Having a good bedtime routine, reading to your child before bed, or singing them a lullaby will encourage language development, and the sound machine may ensure a good night’s sleep.  Just turn it off in the morning!

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

Daily Dose

Ear Tugging & Your Child

1.15 to read

I see a lot of parents who bring their baby/toddler/child in to the pediatrician with concerns that their child might have an ear infection. One of the reasons for their concern is often that their baby is tugging on their ears.  

Babies find their ears, just like their hands and feet, around 4 -6 months of age.  I guess a baby must think “this ear tugging is fun and feels good” as maybe babies have “itchy” ears just like adults. It also seems to be a self soothing habit for other children who seem to pull on their ears when they get tired and cranky.  Maybe it is related to new molars coming in at the back of the jaw line?   

Whatever the cause, it often concerns parents who are told by their friends or relatives, “I am worried, this ear pulling probably means the child has an ear infection”.  So, being a good parent off you go to your pediatrician only to find out that the ears a beautiful and clear! 

Most babies and children do not get an ear infection without ANY other symptoms besides ear pulling.  In most cases infants and toddlers will get a secondary ear infection during cold and flu season. The multitudes of viral respiratory infections that children get in the first 3 years of life, often cause continuous runny noses and congestion. This congestion causes fluid to build up in the middle ear space which connects to the nasal passages via a small canal called the eustachian tube.   

Infants and children have so called “immature” eustachian tubes that are soft, and don’t drain well and the tube gets inflamed and swollen from the viral infection as well.  At times this fluid gets secondarily infected from bacteria that find their way to the middle ear.  Voila....an ear infection ensues. 

So, if a parent brings their child in for “pulling on their ears” and they are otherwise well (no cough, congestion, runny nose and sleeping well) I usually ask if they want to “wager” if their child has an ear infection.  That is really not fair, as this sweet parent is only concerned because typically someone else told them they should be.  But, in this case a quarter bet is usually made and I end up with a lot of quarters.  (they are good for all of the other bets I do lose with parents and kids about all sorts of things). Friendly betting at the pediatrician’s office, wonder if I am going to be investigated! 

Don’t worry about simple ear pulling especially when you see it happening all of the time.   

Lastly, with the new guidelines for prescribing antibiotics for an ear infection parent’s don’t need to worry as much about a prescription for antibiotics and a few days of waiting will not hurt.  

Daily Dose

Dealing With Family Stress

1.15 to read

With all of the chaos going on in our world it seems that every patient or patient's parent is feeling a lot of stress right now. The most interesting thing is that children are quite intuitive and pick up on the stress around them, from parents and teachers to friends, and even from the background conversations playing on radio and TV.

It certainly seems that it is quite difficult to get away from all of this right now. For school age children (grades one - 12), and even the college set, one semester over and gearing up for the next half of the year and mid-term exams are just around the corner. It is just a tough month.

From headaches to stomach aches, and sleeplessness to fatigue and anxiety, these symptoms may all be a manifestation of stress. The best way to help stress is to acknowledge it and then figure out how to face it in a healthy manner.  

Deep breathing exercises, yoga, meditation, and even listening to your favorite music are all good ways to relax and unwind. A good way to de-stress as a family?  No TV after dinner. Play a game, talk to each other, go to the YMCA or the gym as a family. This is the perfect time to get those endorphins flowing with positive energy, and exercise is a great way to do that.  

Put the cellphone away (you and your kids) no distractions because you may miss something! A walk with your family is free, and you might be amazed how much better everyone feels at the end of their day.

That's your daily dose, we'll chat tomorrow. How do you deal with stress? Let me know...would love to share your success story!

Daily Dose

The Facts About Swine Flu

With the swine flu topping the news I thought it would be prudent to discuss it here as well.042609healthlines With the swine flu topping the news I thought it would be prudent to discuss it here as well. Swine flu is an Influenza A virus that is typically seen in herds of pigs or in those people who come into contact with pigs. In this case the Influenza A that has been detected (Swine Flu, H1N1) is a flu that has both swine, avian and human virus in its genetic material. It also seems to be spreading across the country as well as Mexico and Canada from person to person contact. The virus has already sickened several thousand in Mexico, where it was first reported in March of this year.

There have been as many as 80 deaths reported in Mexico secondary to swine flu. In the U.S. new cases are being detected everyday, and the patients have typical symptoms of flu: high fever, cough, body aches, sore throat, congestion and may have GI symptoms of vomiting and diarrhea. To date cases have been diagnosed in California, Texas, Ohio, Kansas and New York. More cases seem sure to follow as doctors become more aware of the illness and begin testing for swine flu and sending specimens to the health department for further testing. This year had been a relatively mild flu season across the country. With the emergence of swine flu it seems that we may be in for a late spring and summer flu with an influenza virus that has not been seen before. This is important as it means that more people are susceptible to swine flu as we do not have antibody to that virus. Flu viruses are passed person to person by respiratory droplets as well as by contact with the virus on surfaces that then get transferred to our hands where the virus may then be inoculated into our eyes, nose and throat when our hands come into contact with our face. (Think of how many times a day you rub your eyes, nose, or children's little fingers go in their nose or mouths?!) The CDC has said that the swine flu is antigenically different from the Influenza A virus contained in this years flu vaccine and therefore there is not protection from getting swine flu even if you have had the flu vaccine. This too is cause for concern and more studies are being done in efforts to make a new vaccine quickly if the virus becomes a pandemic. The good news is that swine flu seems to be sensitive to the drugs Tamiflu and Relenza . These drugs must be started within 48 hours of flu symptoms to be effective in shortening the course of the illness. Tamiflu may not be used in children under one year of age, and Relenza is not approved for children under seven years. If you are sick, or have children that are sick with flu like symptoms, do not go to work or send children to school. The flu is most contagious during the first four days of the illness. The only way to prevent spread of the flu is to stay home and away from other people. The best protection against viral illnesses continues to be good hand washing!! That's your daily dose, we'll chat again tomorrow. More Information: Centers For Disease Control and Prevention

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Daily Dose

Chubby Toddlers & Weight Gain

1:30 to read

So, what goes on behind closed doors? During a child’s check up, I spend time showing parents (as well as older children) their child’s growth curve. This curve looks at a child’s weight and height, and for children 2 and older, their body mass index (BMI). This visual look at how their child is growing is always eagerly anticipated by parents as they can compare their own child to norms by age, otherwise called a cohort. 

I often then use the growth curve as a segue into the discussion about weight trends and a healthy weight for their child. I really like to start this conversation after the 1 year check up when a child has  stopped bottle feeding and now getting regular meals adn enjying table food. 

This discussion becomes especially important during the toddler years as there is growing data that rapid weight gain trends, in even this age group, may be associated with future obesity and morbidity. Discussions about improving eating habits and making dietary and activity recommendations needs to begin sooner rather than later. 

I found an article in this month’s journal of Archives of Pediatrics especially interesting as it relates to this subject.  A study out of the University of Maryland looked at the parental perception of a toddler’s (12-32 months) weight. The authors report that 87% of mothers of overweight toddlers were less likely to be accurate in their weight perceptions that were mothers of healthy weight toddlers. 

They also reported that 82% of the mothers of overweight toddlers were satisfied with their toddler’s body weight. Interestingly this same article pointed out that 4% of mothers of overweight children and 21% of mothers of healthy weight children wished that their children were larger. 

Part of this misconception may be related to the fact that being overweight is becoming normal.  That seems like a sad statement about our society in general. 

Further research has revealed that more than 75% of parents of overweight children report that “they had never heard that their children were overweight” and the rates are even higher for younger children. If this is the case, we as pediatricians need to be doing a better job.  

We need to begin counseling parents (and their children when age appropriate) about diet and activity even for toddlers. By doing this across all cultures we may be able to change perceptions of healthy weight in our youngest children in hopes that the pendulum of increasing obesity in this country may swing the other way. 

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

Daily Dose

How is School Going?

1.15 to read

So with everyone back in school, I am already discussing “how is school going?” during my patients check ups. This question is great for kids from 5-18 years of age and you get various amounts of feedback depending on age and gender!  The elementary school set is usually talkative and goes into great detail about their teachers and classmates while most of my high school students just tell me their classes are “hard” and they are “busy and tired”.

The cutest comment came last week from an 8 year old little girl. She had only been in school a few days and when I asked her how it was going she said, “I am nervousited”.  What a great way to sum it all up! Of course she was both nervous and excited. A great way to sum up the start of school.

I think any of us at any age can understand being “nervousited”. The start of any new school year typically comes with excitement about the next grade, or a new school,  and a new teacher.  The start of school also makes many children, as well as their parents and teachers a bit nervous.  New friends to make, new expectations for the next grade level, new lockers....the list is very long for some.

But, I think we parents can help our kids to understand that being “nervousited” is normal and healthy.   Reassurance, good listening to our kids concerns and comments will make the new school year get off to a good start.

I must say I am still “nervousited” with the new TV show each week....but I am hopeful that it gets easier each week, right??  Stay tuned, will let you know if those butterflies go away in the next few months as I get used to this new gig...same as a new class. 

Daily Dose

Heart Murmurs

What can you do if your child has an "innocent" heart murmur?I received an email from Brinley who was worried that her 1 year old had recently been found to have an “innocent heart murmur” and she wondered what this meant. Did she need to see a specialist? A heart murmur is simply an extra sound the doctor hears when listening to your child’s heart with their stethoscope. A murmur is caused by the flow of blood through the heart or the major blood vessels around the heart. In the case of an “innocent” heart murmur the flow is through a completely normal heart and is solely due to turbulence but there is nothing else wrong with a child’s heart therefore, the term ”innocent murmur”. These murmurs may also be called functional, benign, or a Still’s murmur. Innocent murmurs are very common and may be heard at different times in a child’s life. Some cardiologist’s quote that somewhere between 50 - 90% of children will have an “innocent murmur” at some time during their childhood. None of these children have any underlying cardiac pathology. It is quite common to hear an “innocent murmur” in a child due to the fact that their heart is close to their chest wall, especially in thin children. It is also not uncommon for the doctor to hear the murmur on one exam and maybe not on the next, as it depends on the position the child is in when they are examined as well as other factors. Fever is one of the most common reasons that a child is found to have an innocent murmur as their heart rate is typically higher and the blood flow is more dynamic. The quality of the murmur is what lets the doctor know that it is an “innocent murmur”. Murmurs are graded on intensity from a grade 1 to grade 6 (the loudest). Most benign murmurs are a grade 1 or grade 2, and they have a musical or vibratory quality. If you have concerns about an innocent murmur a pediatric cardiologist may be consulted. In most cases they will not only listen to your child’s heart, but also do an EKG and an echocardiogram to ensure that your child’s heart is structurally normal. Don’t worry. These murmurs usually go away as your child reaches adolescence. That's your daily dose for today. We'll chat again tomorrow.

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