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Daily Dose

How to Treat Poison Ivy

1.15 to read

With the long weekend here, many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your child has come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

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

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

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

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. 

 

 

Daily Dose

Stay Sun Safe

Memorial Day weekend is the unofficial start to summer. Be sun smart all summer long.

With the long Memorial Day weekend here, it is another good time to discuss the importance of using sunscreen. Sunscreen labeling is about to undergo some changes which will probably make it easier for all of us to read labels and understand how to use sunscreen appropriately. The FDA has been working for over a decade on standardizing labels as to the amount of UVA sun protection each sunscreen product provides. UVA rays, are not the ultraviolet rays that lead to sunburn, but they are the rays that contribute to skin cancer and sun related skin aging. Many products have claimed to be waterproof, sweat proof, or even provide all day protection and these labels will no longer be allowed. At the same time labels promising over 50+ protection will also be pass
Daily Dose

Summer Viruses

1:30 to read

June….now seems like officially summer, although there are still some schools around the country in session, and even a couple in Dallas.  So, with summer here it is check up time in my pediatric office.  That means most days I am seeing very few sick patients, and most of the patients who come in for a visit other than a check up have a rash, a bug bite or maybe a swimmer’s ear.

 

But, with that being said there are also always some of those pesky summer viruses hanging around and many of them appear with just a fever. Many of the “sick” children I am seeing only have a fever, some of whom have a temperature as high as 103-104 degrees, with very few other symptoms.  Although these kids have a significant fever, once they are given an over the counter product like acetaminophen or ibuprofen they feel pretty well and even play for awhile. 

 

Fever is often just a symptom of a viral infection and these summer viruses have names…enterovirus, adenovirus, and even some left over parainfluenza virus.  We are definitely out of flu season….at least till next year.

 

Some of these summer viruses may have associated rashes which are more common with summer viral infections than winter viruses.

 

I have seen some kids with these summer viruses with prolonged fever, even 5-7 days which is a bit longer than a pediatrician and a parent want to see. But, with that being said, when I have seen these children they appear to look well and have not had any other physical findings.  I have often seen them again after having 5 or more days of fever, and it seems that many of them have adenoviral infections.  Adenovirus may also cause a myriad of other symptoms than just fever, including pink eye, sore throat, abdominal pain and vomiting and diarrhea and tummy cramps.  Rarely, some children will develop blood in their urine without having a urinary tract infection. 

 

Parents often ask me….where did they catch this? Remember that these are just viral infections and that there is not a vaccine for adenovirus. Once we see one virus in the community I know I will continue to see more and more children as it is “passed around”.  Best thing to do is to keep up good hand washing and keep your child home from the pool or summer activities if they have a fever.  

 

Daily Dose

The Truth About Bedbugs

With everyone finishing out summer vacation and trips to near and far, and away from one’s own bed, I wondered if any one had been unfortunate enough to develop bites secondary to bed bugs? Bed bugs, also known as Cimex Lectularis have been a known human parasite (remember the lovely louse in hair) for centuries. It is only recently that there has been a resurgence of this blood-sucking insect in all parts of this country and the developed world. YUCK!

Bed bugs are flat, oval shaped and about 5mm long. They seek warmth and that helps them locate warm-blooded bodies. They usually avoid the light, and hide in mattresses, crevices of box springs, headboards, and even behind hanging pictures. Did you know that they can survive a year without feeding? No wonder we are loosing the bed bug fight. We humans also help to move them from location to location via clothing, suitcases, personal possessions and bedding. Now I am really thinking about moving my son into that dorm next week!! Looking at the literature (JAMA, April 2009) it seems that more than 40 diseases have been attributed to bed bugs, but there is little evidence that such transmission has ever occurred. It is the reaction to the bite that it most bothersome as well as the mental anguish associated with it. The usual response to a bed bug bite is to little to no reaction at the site of the bite. About 30 percent of people will develop more significant reactions with larger local reactions that are more bothersome. These bites may be treated with oral anti-histamines and topical steroid cream, and seem to resolve over several weeks. An antibacterial cream may be used if the bites become locally infected due to scratching. With all of that being said, there are currently no repellents that have been shown to be effective. Mosquito repellant and oil of lemon eucalyptus may be of some help, but wearing these to bed every night doesn’t sound wise. Pesticides for spraying mattresses are also a cause of health concerns and are not routinely recommended. Let’s just hope we are all in the 70 percent that don’t know if we have been exposed and leave it at that! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Burns From Hot Surfaces!

1;30 to read

With the ongoing heat wave across many parts of the country which has hit Texas exceptionally hard, I have a new warning for parents (and kids).  My community has seen seen extremely high temperatures between 100-106 for the last two weeks. These temps have made everyone miserable and there have been many warnings about heat exhaustion and heat stroke, and ways to stay hydrated on the news.

Who knew that you needed to worry about burns other than sunburn? It seems that outdoor furniture, metal pool drain covers, and playground equipment have heated up with these unrelenting temperatures!  

So…what is this alluding to?  A patient just called me yesterday totally “freaking out” that her toddler had gone out to play in the backyard with his 3 year old brother. It was morning and not yet terribly hot, so she thought “best time to get out of the house and get some fresh air”.  The boys were climbing on their outdoor fire pit (as children often do) and he stepped on the edge, and immediately started to scream and cry. His mother, who also happens to be a pediatric nurse, initially thought something had stung him? When she picked him up he continued to cry as if in pain, but she could not see anything at all….until she looked at his feet. He had stood on the metal on the edge and immediately burned his feet, to the point of blistering on contact!  And, as you probably know, toddlers feet are typically flat (arches come later) so his “baby feet” had full contact with the metal and he sustained second degree burns to both feet.

When she got him to the ER they immediately started to treat his burns and pain (as burns are incredibly painful).   She said she did not know who was crying more…she or her child. Once things settled down she asked the ER doctor at Children’s Medical Center if this had ever happened before!  Unfortunately, the answer was yes.  They had seen several other serious burns to children who had come into contact with metal on playgrounds and around metal pool drain covers.

This precious little boy will ultimately be fine…..after many days of oral pain medication and routine bandage changes (some of which will actually be done as an outpatient at a burn unit). He will also never remember this.

So… this is a new warning for parents: watch out for the possibility of burns secondary to outdoor metal objects.  This photo is quite telling and painful to look at!  His mother called me today and sent a few new pictures with him smiling!

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DR SUE'S DAILY DOSE

Stay healthy this flu season.

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