Skin and Bones

Dealing with ailing bodies and human foibles all day long, it’s no wonder doctors have a sick sense of humor, me included.  When people show me their kids’ rashes in public, I play it straight and happily consult.  However, occasionally adults will haul up their shirts at parties to show me the latest blemish on their bellies or backs and ask, “Hey Doc, what the heck is this?” I nod confidently: “It’s definitely cancer,” I say. Then I give them a wry smile that says, hey, only kidding!

Given the warm winter we’ve had, the early spring, and the early school closings, I predict a rough summer for rashes.  Children meet the outside world with their skin.  When falling off bikes or monkey bars, not “sticking the landing” as they say in gymnastics, they get scrapes and cuts and bruises.  When they plow through vegetation exploring or searching for stray balls, their skin gets irritated by thorns or poison ivy. Mosquitoes enjoy a blood meal from our children, and later, when the bite itches, they tear at themselves with ragged, dirty fingernails.  Sun cooks hot, exposed skin too.

We’re all learning new habits from Coronavirus concerns, like washing our hands more often and extra carefully, wiping down potentially contaminated surfaces, and trying not to touch our faces.  It’s also a good time to improve skin-care habits for children.  That’s the best prevention for skin injuries and infections that we’ll see in the Emergency Department in the coming months.  Paradoxically, skin is hardest to hurt when it’s soft and pliable.  It bounces back, and heals better.  Hard dry skin cracks under pressure and itches worse when insulted.

Kids should use moisturizing soap. Buy brands like Dove and Caress, which are easy on skin, rather than harsh drying soaps like Ivory, Zest, Dial, or Irish Spring.  Washclothes and vigorous toweling also can irritate, so kids should use only their hands and the soap, and pat dry with towels. Advanced Parenting involves using white lotion to moisturize kids’ skin, putting on sunscreen, and applying bug spray.  When a kid gets a cut or scrape, “rub dirt on it” is just a joke!  Wash broken skin with soap and water, and dress it with neosporin and bandages.  Please keep those grubby ragged fingernails clean and short.

In 2008, New York City mom Lenore Skenazy was shopping with her 9 year-old son.  They had ridden the subway, and that day he begged Ms. Skenazy to let him ride home by himself.  Having taught him how to read subway maps and distinguish between uptown and downtown trains, she decided to let him go.  He got home safely and was ecstatic with his feat.  But when Ms. Skenazy wrote about his adventure in a newspaper column, she set off a storm of controversy.

Some called her the “world’s worst mom.” Child Protection paid her a visit.  Others praised her for giving her child freedoms not allowed by “helicopter parents,” so-called because they hover over their kids’ every move. Ms. Skenazy then briefly had a reality TV series where she coached such parents on letting their kids ride bikes or slice vegetables.  The show’s title: World’s Worst Mom.

Fortunately, we in Acadiana needn’t worry about children navigating crowded cities. But they will be having adventures on bikes and trampolines, or dirt bikes and ATVs.  Most emergencies we’re seeing now are injuries from these. If your child falls off a bike or monkeybars, check the head first.  Head injuries are the most common serious injury in pediatrics.  If the kid has been knocked out or is acting confused, get them into us right away.  Please put helmets on bike-riders before this happens!

If the head checks out okay, limbs are next.  Broken bones are obvious: the child cries and points to the dinged wing.  Sometimes it’s bent in an unnatural way.  The best care for an injured arm or leg is to immobilize it. Preventing the hurt part from moving is the best pain control.  Tape it to a rolled up newspaper or magazine, or a handy board. Give your child some pain medicine, like ibuprofen or tylenol.  DON’T give your child anything to eat or drink.  They’ll need an empty stomach if anesthesia is necessary.

If your child crashes a motorized bike or ATV, you’ll feel like the World’s Worst Mom- these vehicles’ power and speed are too dangerous for little bodies.  Bikes are good enough, and better exercise for their skin and bones.

Is It Broken?

A lot of my columns are about how to keep your child out of the Pediatric Emergency Department.  Possible fractures, though, are one time where coming in is the best move. More on this from our two guest columnists, Dr. Nicole Miller and Dr. Sonja Wilson, Family Practice residents at the University Hospital and Clinics here in Lafayette:

James woke up Christmas morning and ran downstairs to see what Santa brought.  A note on the Christmas tree said “look outside!”  He opened the back door to find a new trampoline!  James quickly dressed and ran out to enjoy his new toy.  After a few bounces though, he found himself on the ground crying in pain.  His shin was swollen, and it hurt too much to get up and walk.  James and his parents went to the Emergency Department and found that he had fractured his leg.  On Christmas Day!

The holidays are here and with this will come new toys and activities.  Kids will be out of school and spending time on bikes, ATVs, trampolines, and scooters.  In the ER at Lafayette General we will be seeing more visits for injured hands, wrists, arms, feet, ankles, and legs.  What is a family to do?  Start by preventing these injuries!

Part of preventing fractures is having good bone health.  This starts with a healthy diet. The American Academy of Pediatrics (AAP) recommends that kids get 400 International Units (IU) of Vitamin D every day.  One cup of milk is 100 IU.  Vitamin D can be found in a variety of foods and drinks, including soy products and orange juice.  Your skin can make Vitamin D as well, as long as it is exposed to sunlight.  Kids should have at least 15 minutes in the sun every day.

How to prevent an injury?  The AAP recommends against having children operate ATVs or other gasoline-powered vehicles, and recommends against having a trampoline.  These are known to have a high risk of causing fractures or even more life-threatening injuries. The key to safe toys is to keep in mind the age, size, and maturity of your child.

When buying new toys like bikes and skateboards, don’t skimp on the safety accessories! Also buy helmets for bikes, and helmets and knee/elbow/wrist guards for skateboards. Learning to ride a bike also means learning traffic rules for bike safety.

Find a safe place for your child to play.  Avoid busy roads, hills, and streets with multiple parked cars.  Always supervise your kids while playing.  Even with all of this protection, kids get hurt.  Kids play and explore and fall down.  Usually this results in simple bruises and sprains, but sometimes a broken bone results.

When should you worry?  Signs of fracture include bruising and swelling over a bone, a snapping sound on impact, difficulty walking or using the injured limb, and obvious crookedness in the limb.  It is harder to tell if young children have a fracture; they can’t tell you about the pain they are experiencing.  If a toddler stops using a hurt limb- bring them in.

So what should you do if you think your child has a fracture?  First, limit movements of the hurt limb- apply a splint of rolled up magazines taped around the hurt bone.  DO NOT GIVE YOUR CHILD ANYTHING TO EAT OR DRINK UNTIL YOU SEE A DOCTOR!  If the bone is broken your child may need sedation or anesthesia to fix the bone, and an empty stomach is essential before sedation.  Then bring them in to a place with an x-ray machine.

While some practices and urgent care clinics have x-ray, that is not all you need for fracture care.  The facility also needs to be able to put on a splint or cast and have access to an orthopedic surgeon.  For some fractures the bone may need straightening, and then the facility needs to be able to safely sedate the child and/or have an operating suite equipped for children.  Call ahead to the place you plan to go to be sure it has all the services your kid might need.

Have a safe holiday season Acadiana!