Strep throat is caused by a bacterial species called Streptococcus pyogenes. There are more than 100 types of strep based on their cell structure. Of these, a small number produce a toxin that can cause scarlet fever.
The symptoms of strep throat include fever, sore throat, headache, stomachache and fatigue. On examination, a child will typically have red and swollen tonsils with or without pus and swollen, tender lymph nodes where the neck meets the jaw. With scarlet fever strains, a child will develop additional findings: a red, strawberry-appearing tongue and a sandpapery or gooseflesh rash on the body. A week or so after the infection resolves, the skin on the child’s body may peel.
Before the development of antibiotics, scarlet fever was a deadly disease. As a result, some people (especially grandparents) may worry if they hear that a child has scarlet fever. Nowadays, scarlet fever is a different illness, and doctors just consider it a strep throat with a rash.
One fact about scarlet fever is very interesting. It appears that not only does a child have to be exposed to a certain strain of strep to develop scarlet fever, but his body has to react to the bacteria in such a way that the rash occurs. Although I have experienced hundreds of patients giving strep to their brothers and sisters, I have never had two cases of scarlet fever in the same family at the same time. This doesn’t mean it can’t happen, just that it’s quite rare.
In the past, babies rarely got funny shaped heads because they slept on their tummies. When we started putting babies to sleep on their backs 20 years ago, unusual head shapes started to be noticed. The pictures above show three types of head shapes: symmetrical, plagiocephaly (flat on one side) and brachycephaly (flat along the back).
A baby’s head will take on an unusual shape if he spends more time sleeping with his head in one direction. This occurs because more pressure is applied to one area and the head “molds” the corresponding location. In most cases, this represents a temporary finding that will resolve over time.
When pediatricians examine babies with unusual head shapes, we look for two problems. This first is a common condition called congenital muscular torticollis. If a baby has torticollis, the neck muscles that bend and rotate the head are tighter on one side causing the baby to spend more time turned in one direction when asleep. It many cases, it will also be noticed when the baby is awake. Over time, this will deform the shape of the skull. Torticollis is treated with physical therapy or watchful waiting depending on its severity.
The second is a rare condition called craniosynostosis. In this situation, one of the skull bones is not growing properly because it is “stuck” to the opposing bone, causing a misshapen head. If there is a question whether your baby has this condition, he will be x-rayed or referred to a pediatric specialist (neurosurgeon or plastic surgeon) for a thorough evaluation.
For the past 10 years or so, companies have sprung up to “fix” plagiocephaly and other asymmetric head shapes. A handful of studies have been published showing that this is not necessary. If your baby’s head is flat on the side or back because of positional forces, the problem will usually resolve by 2 to 3 years of age. The head may not look perfect, but a corrective helmet won’t make it look any better.
Now that babies sleep on their backs, it’s important for them to get tummy time throughout the day to help strengthen the muscles in their arms, neck, shoulders and back. I usually recommend that parents start tummy time when babies are 4 weeks of age. You could do this sooner, but I figure parents have enough things to worry about in the first month without putting tummy time on their list.
There is no “right way” to do tummy time, but it makes sense to do it when babies are alert. First, put the baby tummy down on a firm surface like a couch, bed or the floor. If possible, lie down next to the baby, which will encourage her to look up and see your face. If the baby is fussy, you can help support her upper body by pulling her elbows in to her sides. If you smile and talk to your baby, she will be more likely to work her muscles to make tummy time a success. If your baby is still fussy, try putting her on a slant to make it easier to look up. The best way to accomplish this is to put her on her father’s chest while he is lying at a 30-degree angle.
Do tummy time for 5 to 15 minutes a handful of times during the day and evening. Obviously, how long tummy time lasts will depend on your baby’s interest. Never leave the baby alone in this position, even for a second, or she may roll over and hurt herself. Likewise, make sure you are alert because we don’t want babies to fall asleep during tummy time because that is a SIDS risk just like sleeping on their tummies at night.
When a newborn’s penis is circumcised, the head of the penis (glans) will be red and wet looking for 3 to 5 days. During the healing process, it’s common for the glans to develop small yellow patches. These areas are part of the healing process and do not mean the baby has an infected circumcision. (If you’ve ever had a cut inside your mouth, you’ll recall that it heals with a whitish or yellow patch rather than a tradition scab. The same thing happens to a circumcised penis.)
I’ve been practicing pediatrics for over 30 years, and I have never seen an infected circumcision. If this were to occur, the redness would extend from the glans to the shaft and then towards the baby’s body. If you see this, call your doctor right away.
In my last blog, I mentioned that 6 muscles control the movement of each eye. This is a lot for a newborn’s brain to coordinate. As a result, it’s common for a newborn’s eyes to “wander” in the first few months of life. In most cases, the eyes move inward instead of outward. They are also more likely to wander when a baby is tired.
If the family history is positive for strabismus (lazy eye), the baby’s eyes are constantly out of balance or the baby’s eyes wander after 6 months of age, she should see a pediatric ophthalmologist. Keep in mind that eyes are supposed to converge (come together) if someone is looking at an object close up.
Like all referrals, it’s best not to schedule the appointment during the baby’s nap time because she’s more likely to cooperate with the exam is she isn’t tired.
Newborn babies will look at their parents right after birth, but their eyes can’t do more than “fix” on objects for a few weeks. Between 1 and 2 months of age, babies will begin to follow objects during quiet, alert periods. It’s important to realize that this is still a difficult task. There are six muscles that control each eye, and they must work in unison for a baby to follow an object through space.
The best way to get your baby to follow is to put your smiling face 12 to 18 inches in front of her face. Then, move your head slowly in one direction or the other. Most babies will be able to follow you for an arc of about 30 to 45 degrees. After that, their eyes may stop or wander a bit.
Have you ever watched a TV show where someone who’s having a heart attack grabs his left arm or shoulder? Have you ever had a stabbing pain in your forehead or the bridge of your nose after eating ice cream too quickly? With a heart attack, the source of the pain is in the person’s chest. With a brain freeze, the source of the pain is in the roof of your mouth.
Referred pain occurs because the body’s sensory nerves occasionally send signals in the wrong direction. The following examples commonly occur in children:
- When children complain of mouth, cheek or tooth pain, they sometimes have an ear infection.
- When children complain of ear pain, they sometimes have a throat or lymph node infection in their neck.
- When children complain of knee pain, they sometimes have a problem in their hip or testicle.
- When children complain of low back pain, they sometimes have constipation.
- When children complain of stomach pain in the middle of the night, they sometimes have a pinworm infection.