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.

BZZZZZZZZZZ

This week’s guest columnist is Dr. Allan Olson, a Family Practice resident at University Hospital and Clinics here in Lafayette.

It’s mosquito season again- never far away in Louisiana.  Usually bites are harmless, causing some redness, itching, and swelling that goes away within hours.  Ten years ago mosquito bites were just a nuisance, but now the news is full of stories about Zika and Dengue, and remember West Nile virus?  So when to worry?

Your 10 year-old son played outside this afternoon.  When he came in for supper he had two itchy, raised, red areas on his arms and one on his neck.  Other than some rubbing and scratching, he seems fine.  Should you be concerned?

Not yet: your boy is behaving normally, has no fever or other symptoms besides the bites.  You tell him to stop scratching- good luck with that!  When mosquitoes bite, they inject an anesthetic so you don’t know they’re biting and can’t swat them.  But then later some people develop a tiny allergic reaction to that anesthetic, and thus the spot of swelling and itching.  And when kids itch, they scratch, and no words can stop that.

To get rid of the itch,  use anti-histamines like Benadryl, Claritin, or Zyrtec.   Ibuprofen or Tylenol can take the edge off itching too, and can safely be taken with an anti-histamine.  Also, keep your kids fingernails cut short.  If they tear the skin with scratching, that broken skin is an entry for bacteria, and infections and pus can result.  If your child has extra sensitive or dry skin, keep it moisturized with lotion and moisturizing soap, making it less itchy and less easily torn by fingernails.

Even better, keep those bites from happening!  Mosquito buzzing is no reason to stay inside all day playing video games.  Kids need exercise (besides their thumbs) to stay healthy, not to mention wearing them out so they’ll sleep at night.  Have your kids wear light, long sleeved clothing and pants, with cuffs tucked into socks.  Too hot for that, or too dorky for your kid?  Repellents with DEET or picaridin can help keep insects away.  Avoid being outside when mosquitoes are most active- dusk, dawn, and after rain.

Here’s a different mosquito scenario than from our boy above.  Your teenage daughter goes on a mission trip to Central America with her church.  She was helping out at a clinic in a remote village, and gets some mosquito bites.  Two days after coming home she begins to feel bad- with fever, headaches, nausea.  Her body aches and she’s tired.  Knowing that many infections transmitted by mosquitoes get better on their own, you give her Tylenol and have her drink plenty of fluids.  So when to worry now?

These days with Zika virus in the news, heck, you’re already worried!  So you take her to your doctor or the ER.  Most of the time though, these mosquito-borne infections are viruses that run their course and leave your daughter fine.  Occasionally, kids may need tests to look for one of the bad infections like West Nile, Dengue, or malaria. They may need fluids for dehydration or specific medicine for pain.

Many countries in the Caribbean, Central America, or South America have increased risk for mosquito-borne diseases like Zika, Chikungunya, yellow fever, West Nile, Dengue, or malaria.  If you or your kids are working or vacationing there, preventing these illnesses is way better than getting them!  Sleep under mosquito netting, in a room with screens on the windows.  Air-conditioning helps: you can sleep in a more sealed room, and the cool air makes mosquitoes less active.  Use repellents and protective clothing as mentioned above.

Before you go, check the Centers for Disease Control website (www.cdc.gov).  The CDC lists the disease risks for every country in the world, and what you need before you go.  If yellow fever is prevalent, get vaccinated for that.  For malaria prevention, the site tells you what antibiotic to get from your doctor, when to start taking it, and when to stop.  It’s a pretty cool site (at least we doctors think so), so check it out.

Don’t let those mosquitoes disrupt your kids’s outdoor fun or travel plans.  Take these steps to help them have a great summer at home or on the road.  And so you don’t have to panic when you hear BZZZZZZ.