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.

More Itching, More Rashes

Last week’s blog post on eczema brought to mind two other common rashes we see in the Emergency Department: hives and poison ivy.  We see hives a lot because it really does look bad, and is associated with bad allergic reactions.  When a kid is covered with itchy welts, especially when they have blotches on their face and around their eyes, parents think about other scary allergic reactions: Will my child start to wheeze and struggle to breathe?  Will his throat close up?  Will she go into shock?

The good news is that hives, or ”urticaria” in doctor-talk, by itself is not dangerous.  If your kid has had hives for an hour or two without any of that bad stuff above, rest easy.  The bad allergic reactions- throat swelling, wheezing, anaphylactic shock- happen immediately in an allergic reaction.  Hives are also quite common.  Most kids have an attack of hives sometime in their childhood, and they get over it just fine.

What causes hives?  When a kid comes in covered with itchy welts, the parents have already been racking their brains for causes.  What food did he eat?  Did we use a new washing powder?  Did she get bitten by something?  It turns out that most urticaria episodes have unclear origins.  In fact, if the kid gets allergy testing after a hives outbreak, most often all the tests are negative.  Only if the child has just taken something highly allergenic before the attack, like antibiotics or allergenic foods like peanuts, do we have a possible culprit.  For most kids though, there is no obvious cause.

How do you treat urticaria?  As you probably could guess, use good old Benadryl.  Benadryl is good for the itching, and makes the rash look better.  Tylenol is also good for itching and is safe to take with Benadryl.  If the Benadryl still is not enough to keep your kid happy, sometimes we add steroids.

More good news about urticaria is that it is short-lived.  Most kids are better in 2 to 4 days.  Rare cases last longer, and those are the few kids who need allergy testing.  Otherwise, if your kids has hives, don’t panic!  Give some benadryl, maybe some tylenol, keep them cool and their skin soft.  And don’t go too nuts trying to figure out a cause- you won’t!

Poison ivy is another common non-emergency rash that we see in the Emergency Department.  It may not be an emergency, but like hives and eczema it sure does itch like crazy, and looks awful.  It is red, streaky, and often has pustules and wet, weepy patches.  Kids commonly get it on their faces and arms and legs, since these are the places skin is exposed and brushed by the poison ivy leaves.

Poison ivy is one cause of a class of rashes we call “contact dermatitis.”  In other words, any irritant that contacts your skin can cause this rash.  Other irritants, like poison oak, poison sumac, or any other thing your kid’s skin is allergic to, can cause a break out.  Myth buster: many people think poison ivy is contagious, that you can spread the “oil” that causes the rash to others.  THIS IS WRONG!  Poison ivy and other contact dermatitises are not contagious.  It seems contagious when a kid as more and more break-outs on his own body, as if he is spreading it around by scratching.  In reality, the kid is just having later breakouts where his body got a lower dose of the allergen.

To treat poison ivy, we use steroids again.  Steroids are anti-inflammation medicines, and calm down the skin inflamed by the irritant.  Another myth-buster: steroid injection, the “cortisone shot,” does not work any better or faster than steroid pills or syrup.  Other treatment for poison ivy includes covering the really raw spots with bandages, and giving Tylenol or ibuprofen for the itch.  Poison ivy can take as long as a week to heal.

So if your kid has poison ivy, dress the worst patches and give him or her some Tylenol for the itching.  Call your doctor for a steroid prescription and tell his teachers he is not contagious.  Tell them you heard it from me!