Does it hurt to wash your baby’s soft spot?

Pressing-Babys-Soft-SpotThe medical name for a baby’s soft spot is called the anterior fontanel. This is an opening between the bones of the skull that allows the cranium to grow. The fontanel is covered with a very tough membrane so you will not hurt it when you wash your baby’s hair. Although doctors would never recommend poking the fontanel, you can scrub it gently with a hairbrush like the rest of your baby’s scalp.

Does your child have hives?

Hives in ChildrenWhen parents call me about rashes, I often hear that a child has “hives.” In most cases, parents use this term incorrectly. The question is, does that matter?

The factors that cause most rashes in children are environmental (insect bites, heat rash, allergic reactions) or infectious (viruses, bacterial, fungal). Hives are usually caused by viruses, but they can also occur with strep and allergic reactions to foods. (If you suspect that your child has hives because of an allergic reaction to a food, you should give him Benadryl and call the doctor right away. If your child also has coughing or trouble breathing, you should call 911 in case he’s having an anaphylactic reaction.)

The thing that distinguishes hives from other rashes is the margin between the normal skin and the rash. Most of the rashes children get consist of flat areas with or without a scale and small, raised bumps. (Doctors call flat rashes macules, bumps papules and hives wheals.) Papules come in different sizes, but they have one thing in common. The region between normal skin and the lesion rises slowly like a hill. With wheals (hives), the region between normal skin and the lesion rises more sharply, like a plateau. If you’ve ever seen a welt, the raised area at the edge is more characteristic of a wheal than a papule.

When can kids with hand, foot and mouth syndrome return to school?

Hand Foot Mouth in KidsMost children contract hand, foot and mouth syndrome before kindergarten. The infection is usually caused by a member of the Coxsackie virus family. It typically presents with fever, sore throat and small blisters on the palms and soles. Some strains of the virus also cause a red bumpy rash on the body. The treatment is the same as it is for most viral infections: rest, fluids and fever control.

When I see kids with hand, foot and mouth syndrome, parents usually ask two questions. (1) How long is the child contagious? (2) When can she go back to daycare or school? The answer to the first question surprises parents. They’re contagious for 2 to 3 weeks after they get sick. The answer to the second question surprises them even more. Kids can return to school as soon as they feel better. What? How can doctors send kids back to school when they’re still contagious? The rationale for this is simple. Up to 20% of children with hand, foot and mouth syndrome are asymptomatic. This means they contracted the virus and are spreading it to others even though they’re not sick themselves. That fact, combined with the long contagious period, means keeping kids home will have no impact on the spread of the disease. That’s why we send them back when they feel better.

Care of the uncircumcised penis

It is common knowledge that you don’t have to pull back on a baby’s foreskin to get it to detach from the head of the penis (glans). This is a natural process that will occur as the baby grows. Like many aspects of growth and development, a child’s foreskin detaches from the glans gradually. Once the foreskin is fully retractable, it’s important to clean the glans daily with mild soap and water. The purpose of this cleansing is to keep the penis clean and wash away any smegma that accumulated under the foreskin. Smegma is a whitish, greasy substance that is found normally in uncircumcised males.

There is a finding that may occur in uncircumcised children, which can worry parents. Smegma sometimes accumulates under the foreskin before it fully retracts. These accumulations are called “smegma pearls” because they have a round or oval appearance. Most of the time, they are whitish, but on occasion they have a yellowish hue. If this happens, parents may conclude that their child has an infection. There is an easy way to determine if the child has foreskin infection vs. a smegma pearl. The tissue surrounding an infection is red, swollen and tender. If your baby has a white or yellow accumulation under the foreskin that doesn’t look angry and isn’t tender to touch, it’s not likely to be infected. Of course, if you have any questions about this, call your doctor.

An uncommon, but serious side effect of acne medication

Tetracycline and its derivatives (doxycycline, minocycline) are commonly used to treat acne. I have noticed that dermatologists sometimes forget to warn patients that a severe sore throat may occur if these medications dissolve in the esophagus. This can occur if the capsule “gets stuck” on the way down or if a teenager has an episode of stomach reflux while lying down and the capsule washes back into the esophagus. Although there is a warning label on the bottle that instructs patients to take the medication with lots of water, people do not always read these labels. 

To avoid this situation, I always tell teenagers why it is important that the capsule makes it into the stomach. I also prefer derivatives such as doxycycline because they can be taken with food. This reduces the chance that the pill will lodge in the esophagus and circumvents the need to take the medication on an empty stomach before bed. If one of my patients remembers to take his acne pill within an hour of bedtime, I tell him to skip the dose that night. 

A Modified Sitz Bath Helps With Mild Vaginal Irritation

A common symptom in preteen girls is pain with urination. Although it is important to consider a urinary tract infection (UTI) in this situation, the following conditions can cause painful urination because they irritate the tissues around a child’s urinary opening. These conditions are more common than UTIs. 

  • poor hygiene (or wiping in the wrong direction)
  • bubble baths
  • prolonged bathing where a child washes herself and then sits in a soapy tub
  • staying in a wet bathing suit for long periods of time during the summer

If your child has mild urinary symptoms without fever, vomiting or abdominal pain, you can consider trying to relieve her vaginal irritation by cleansing her bottom before taking her to the doctor. (Although it is helpful for dads to know about this problem, moms should usually be the ones to assist their daughters with treatment.) 

Fill an 8- to12-ounce plastic bottle with warm water (it is important that the bottle has a “nozzle” on top to so it will produce a stream of water when squeezed). Have your child sit on a toilet with her legs spread and her labia majora pulled to the side. Position the bottle a few inches from the vagina and gently shower the tissues with water. Do the procedure twice a day for a couple of days. If the symptoms increase or do not improve quickly, see your doctor. 

Prescription Creams Have Instructions On the Box, Not the Tube

If you take your child to the doctor because of a rash or skin condition, the doctor will often prescribe a cream or ointment. The instructions will state how often and how long you should apply the medication. Because we are a “throw-away” society, most parents toss the box when they get home and put the tube in a convenient location. If you do this, you will not only be throwing away the doctor’s instructions, but the box also contains the phone number for the pharmacy and whether the doctor gave you any refills. So the next time you get a tube of cream, remember to keep the box it came in.