Twitter Facebook RSS Feed Print
Daily Dose

Why Babies Develop Jaundice

It is not unusual to see a newborn appear slightly jaundiced during their first week of life.

I received an email via our iPhone App from a mom who asked "why babies get jaundice and why we check a bilirubin level on newborns?"

Most babies will develop physiologic jaundice (noted by yellow discoloration to their skin and whites of their eyes) due to the fact that a your-baby's liver is still not working at full speed when first born. Bilirubin, a breakdown product of the red blood cell, is metabolized through the liver. It is also excreted in the stool, and the young newborn is just getting all of those organ systems up and running in the first 24- 2 hours of life. As cute and snuggly as a brand new your baby is, it does take a few hours to days for everything to ramp up to full working speed. So, it is not unusual to see a newborn appear slightly jaundiced during their first week of life, and how I learned with my own first child, yellow is not a good color on most newborns. Stick with pink and blue. Sometimes babies will develop higher bilirubin levels than expected, (numbers in the teens) and depending on how old they are may require phototherapy to help breakdown the bilirubin. You might have seen those babies basking under the glow of "sunlamps" wearing your-baby sunglasses. The blue lights breakdown bilirubin in the skin. Excessive bilirubin can lead to a condition called kernicterus, and may actually cause brain damage. By following an infant's bilirubin levels and treating promptly you can avoid this, and I have never seen an infant develop kernicterus. Your pediatrician will discuss bilirubin levels with you while you are in the hospital with your newborn. If they don't bring it up, typically there is nothing to worry about. If you have concerns, you should ask. If your your baby seems to be getting more jaundiced once you are home, give your doctor a call, it may mean they need to have another bilirubin level drawn as occasionally a your-baby will develop more jaundice once they have been discharged. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

Daily Dose

Diaper Dermatitis

1:30 to read

Newborn babies have the softest little bottoms and they also have a lot of poop! The combination often leads to a raw red bottom and a diaper rash. A newborn often poops every time they eat and sometimes in between....and you don’t even realize they have pooped again.

Even with the constant diaper changing (would you have believed you would use 8-12 diapers a day) it is very common for that newborn to develop their first diaper rash.  Not only will the skin be red and raw....it may even sometimes be so chapped that it may bleed a bit.  This diaper rash is causes a lot of parental concern and will often result in the new parent’s first of many calls to their pediatrician.

A new baby is supposed to poop a lot, so you can’t change that fact,  but you can try all sorts of things to protect that precious bottom and treat the diaper rash.  After using a diaper wipe (non-perfumed, hypo-allergenic) I sometimes bring out the blow dryer and turn it to cool and dry the baby’s bottom a bit. Then I apply a mixture of a zinc based diaper cream (examples:  Desitin, Dr. Smith’s, Triple Paste cream), which I mix in the palm of my hand with a tiny bit of liquid over the counter antacid.  (I don’t measure it:  just a lot of diaper cream and small amount of antacid so it won’t be runny).  I put a really heavy layer of this on the baby’s bottom.

If after several days rash is still not improving it may have become secondarily infected with yeast so I add a yeast cream (Lotrimin AF, Triple Paste AF) to the concoction. If it has yeast this should do the trick to treat all of the problems.

I will also sometimes alternate using Aquaphor on the bottom with the above diaper cream concoction.  It will take some time for it to totally go away but you are trying to get a barrier between the poop and the skin on the baby’s bottom. She keep something on there after each diaper change.

After a few weeks of constant pooping the number of stools do slow down and bit and that will help heal that new baby’s bottom as well. 

Tags: 
Daily Dose

Red Cheeks In Winter

1:15 to read

Why do children get red cheeks in winter?

It is the time of year for cold temperatures, low humidity and dry skin. It is funny, every year as the temperatures drop, I we start seeing these cute little babies and toddlers who have those bright red cheeks. I always say that they “look like British babies”.

Dry skin is just one of the many issues we see with colder temperatures, and babies red cheeks are one of the most evident. During the winter months we all experience dry skin and using moisturizer becomes very important.

I have written previous blogs about eczema, and while chapped skin is not synonymous with eczema, there are some similarities. The most important thing to prevent dry skin while the weather is cold is to use a moisturizer, and applying moisturizer is best on damp skin. After bathing your baby or child, pat them dry until they are just “a tad bit moist” and then take a moisturizer and apply it to the almost dry skin. The thicker the moisturizer the better, so a cream is preferable to a lotion. It will take a little more time to rub the cream in when the skin is a bit moist, but it will help the moisturizer penetrate the skin. The same thing goes for the face.

I always found that the best time for me to moisturize those rosy cheeks was really after the child had gone to sleep. When my children were younger I found that if I put the cream on when they were awake, that they either rubbed their faces more, or if they were verbal, complained about lotion on their faces. So…I decided that it worked best to have their bedtime routine, with baths, books, and prayers, and then once they were asleep I would slip in and lather up their faces and also even used Chap Stick on their dry little lips. Now, there is no science in this routine, but it seemed to work, and they were much more tolerant of lubricants when asleep than awake.

We are definitely in the low humidity season and the heat is on in the house (I am typing this as I sit by the fire with a blanket over my feet), so you can expect several months of dry skin and chapped cheeks. If moisturizers like Vanicream, Cerave, Aquaphor and Eucerin go on sale, stock up!!  April is a long way away.

Tags: 
Daily Dose

Teens & Skin Care

I am seeing a lot of teens this summer for their “routine” checkups and skin care is always part of our discussion.

I am seeing a lot of teens for their “routine” checkups and skin care is always part of our discussion. Some teens are just blessed with good skin, and when you ask them what they do to their skin their reply is “nothing’. That is not the norm. Adolescence is the prime time for acne and whether the breakouts are mild or persistent, good skin care is the beginning for everyone.
The first thing that all adolescents need to do is to wash their face twice a day. You do not need “fancy” skin potions or lotions either, the drugstore has more than enough choices to begin a good cleansing program. Using a mild soap- free cleanser may be enough to begin with , something like Purpose, Basis, Aquanil or Neutrogena. If the skin is more oily and acne prone try a cleanser that contains glycolic or salicylic acid , products like Neutrogena Acne wash, or Clean and Clear, you will need to read labels to look at the ingredients. These provide gentle exfoliation of the skin surface. Wash with a soft cloth but don’t scrub or buff, just wash.
After washing your face in the morning, always apply a gentle non-comedogenic moisturizer WITH sunscreen. This will not cause acne, but will prevent sun damage that we all get on a daily basis. This is not the same as applying sunscreen for a day at the beach or lake. Again, I like Oil of Olay complete, or Neutrogena but there are many others out there, so find your favorite.
At bedtime, after washing your face, if skin seems to be getting break outs begin using a 5% benzoyl peroxide lotion (you only need a dime size amount for the whole face) applied after your face has completely dried from the washing. If it is applied to a wet or damp face it may cause redness. Benzoyl peroxide products come in several strengths and may be titrated up in strength as tolerated.
If this regimen is not working well it is probably time for a visit to the doctor to discuss some prescription products. More on that another day.
That's your daily dose. We'll chat tomorrow.
Tags: 
Daily Dose

Acne Problems

Adolescents and acne….the two often go together. With so many options, both over the counter and prescription available, most teens who are interested in treating their acne can achieve clear skin.  The first step is typically making sure that the tween-teen is washing their face every morning and before bed…which proves to be difficult for some.

 

Interestingly, diet may also play a role in acne. While we were told years ago that french fries and greasy hamburgers may cause acne a new study suggests that milk may actually be the culprit and contribute to the development of acne. I can even remember the dermatologist many years ago asking my sons (who unfortunately all dealt with acne) if they were big milk drinkers.  

 

There have been earlier studies (2005 - 2008) which showed a correlation between milk intake and acne…and the risk seemed to be greater in those that drank non fat milk over whole milk.  The newest study published in 2016 looked at teens with acne compared to controls who did not have acne and found “positive associations with total dairy and non-fat dairy, but not with whole-fat or low -fat dairy. In other words it seemed that skim milk might be involved in the pathogenesis of acne??  There have been proposed mechanisms as to why this might occur, but much of it is speculative.

 

At the same time that teens are developing acne they are also growing and building healthy bones, which means more calcium is needed in their diets. Nutritional guidelines recommend 1,300 mg of calcium every day for adolescents. Much of the dietary calcium intake comes from dairy products including milk, yogurt, and cheese.  It is often very hard for adolescents to meet the daily calcium and vitamin D requirements and stopping dairy may put them at risk nutritionally.

 

But, with that being said….in cases of teenage acne that do not seem to be improving on a well prescribed skin care regimen, it may be prudent to do a dairy free trial to see if this makes a difference in their acne. During the trial you can easily offer a calcium supplement.   If the teen’s face does not seem to improve with a 2-4 week dairy free trial I would recommend to resume normal dairy intake - but maybe use whole-fat or low-fat dairy rather than non fat.

 

This would be a good topic for discussion with your own dermatologist.

Daily Dose

Rashes in Newborns

Newborn rashes are quite concerning to new parents, but are very common and usually innocuous. In the first several days after birth a your-baby will often have a blotchy red rash on their trunk and legs. This rash is called erythema toxicum, and doctors are not sure what causes this in the first days after birth. This red blotchy rash will resolve over the first week of life.

The next thing that parents will notice is that a newborn's skin will seem dry and the newborn will even peel over their feet and ankles and hands. This is common in a term newborn and will resolve, and leave behind beautiful your-baby skin. Moisturizing their skin will also help maintain skin hydration. Over the next month a newborn may develop neonatal acne and have a pimply rash on their face and even shoulders. This is a hormonal reaction, and again doesn't require medication or special soap. Just continue to wash your your-baby's face with warm water and a mild soap. No need for acne wash, or scrubs, and don't be tempted to "pick" them and magically the skin usually clears by two months. All of these issues are frequent worries for new parents and like many things, resolve on their own. It just helps to know how to "name that tune!" That's your daily dose, we'll chat again tomorrow.

Tags: 
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

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.

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

The latest news about the flu.

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.