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.

Hot Times on the Mosquito Coast

Its a great time of year to be a kid- swimming, biking, hiking, camping,and exploring.  TVs, computers, phones, and other screens should be off when the sun is shining, and the kids should be outside playing and exercising.  With the summer rains, it is also a great time of year to be a mosquito.

When kids and mosquitoes meet, itchy bumps result.  The problem with itching is that kids scratch.  Sometimes they scratch so much that they break the skin.  Then their dirty, germy hands drive bacteria under the broken skin, and infections begin.  The itching also just plain drives the child nuts.  They can’t sleep, they whine, summer becomes less fun.

The best way to take care of mosquito bites is to cut down on the kid’s contact with the buggers.  Make sure your screen doors and windows are closed and don’t have holes, so that the bugs don’t get in to the house and attack at night.  Put mosquito repellent on before they go out to play, especially in the early evening when the weather is best but the mosquitoes are worst.

When they do get bites, keep them clean!  Many kids don’t like bathing if they don’t have to, but washing hands and skin before bed prevents infections and soothes skin.  Keep fingernails cut short, so they don’t tear skin as easily when scratching.  If your kid has particularly dry, itchy skin, put moisturizing lotion on after the bath, and be sure to use a moisturizing soap, like Dove or Caress.

If your child does scratch a bite until they bleed, be sure to keep that bite clean, and covered.  After washing with soap and water, dress the bite with neosporin and a bandaid. Hydrocortisone or Benadryl cream can take the edge off the itch too.  Finally, ibuprofen and tylenol take the edge off itching, just like they take away pain.  Give some before bedtime if your kid is a ferocious scratcher- that might help them get to sleep.

But of course, kids can’t help themselves.  They’ll scratch and scratch sometimes- good luck stopping them!- and get that bite infected.  Sometimes when infection takes, it spreads, gets deep, and causes an abscess.  An abscess, or boil, is a pocket of pus inside a shell of painful inflammation.  This is the body’s attempt to wall in the infection and isolate it.  After the infection is isolated, the abscess comes to the skin surface, ruptures, and lets the infection out.  Myth buster: most abscesses are not caused by spiders.  The “spider bite” of legend is actually pretty rare compared to boils caused by kid-scratching.

To prevent abscesses from forming, follow the advice above.  Keep skin clean and soft with daily cool showers or baths.  Use mild, moisturizing soap and moisturizing lotion.  Clean bites and scratches and keep them covered with neosporin and bandages.  Treat the itching with benadryl, hydrocortisone, ibuprofen, or tylenol.

Gross-out Alert!  As I wrote the next paragraph, I realized that you, the reader, may be enjoying your Sunday morning coffee.  If you have a weak stomach about boils and pus, maybe go to the funnies page instead:

Abscesses and mosquito bites are not emergencies.  As above, abscesses pretty much come to a head, rupture, and heal themselves.  Antibiotics are not needed for most abscesses.  They do hurt and occasionally need help to drain.  But often just scrubbing top of an abscess off with a wash cloth after it has “come to a head” (comes to the surface and the pus is visible through the skin) will help the abscess let go.  Be patient with boils.  It takes a few days for them to mature and rupture.  If you squeeze them over and over before they are ready, you may squeeze infection further into the surrounding tissue and spread it.  If they don’t let go on their own in a few days, that is when to see your doctor.

So let your kids play outdoors.  Heck, kick them out!  They need the time away from TVs, computers, video games, and phones, and they certainly need the exercise.  And when they meet mosquitoes and get the itchies, you know what to do.



Mosquitoes and Boils

It is that time of the year, with the hot weather and the summer rains, when the mosquitoes bloom.  It is also the time when TVs should be off and the kids outside playing with friends, getting exercise, sun, and air.  But when the mosquitoes find the kids, itchy bites result.

What does this have to do with the Emergency Department?   Surely people don’t bring their kids to the ED for simple mosquito bites?  Well, they do sometimes, believe it or not.  More importantly however, sometimes kids turn those itches into skin infections and abscesses (also known as Boils).  Then those mosquito bites become a real problem.

When kids scratch, they can tear the skin.  We all have a bacteria on our skin called Staphylococcus, or “Staph.”  Scratching and skin breaks can drive that Staph underneath the skin where it can find lots of nutrients and grow and spread.  Your skin fights back with inflammation (redness, swelling, pain, fever). 

White blood cells collect to fight the infection too, and that makes pus, which builds up into a very painful bubble- the abscess.  Abscesses sometimes need lancing to relieve the pain and pressure and infection.  Occasionally kids need to be in the hospital for IV antibiotics and sometimes surgery to clean up the infection.  

The best way for parents to take care of this problem is prevention.  Keep kids fingernails cut short to help nails stay clean and keep from tearing skin so badly.  Put bug spray or lotion on your kids before they play outside, especially in the early evening. 

After the kids are in for the night, bathe them in cool water, especially washing bites, cuts, and scratches with soap and water.  Cover cuts, bites, and scratches with antibiotic ointment and band aids.  Moisturizing lotion can help itchy, dry skin feel better.  Finally, pain medicines like Tylenol or Motrin also take the edge off itching, and can help kids sleep better and scratch less in their sleep.

If red spots larger than a quarter coin develop, call your doctor.  Your doctor can help you decide if your child needs antibiotics, a visit to the office, or a visit to the Emergency Department. 

Its summer- get your kids outside playing with friends and exercising!  Just use the finger nail clippers and bug lotion first!