RINGWORM
[BACK TO LIST]

General Information: Ringworm is a fungal infection that occurs most commonly on the skin, but can occasionally occur in the scalp. It usually appears as a ring-shaped, reddish patch with raised edges and a clear, flat center. Ringworm is usually about ½ inch across, but can be larger especially if hydrocortisone is placed on it for a few days. It can be transferred from other children or from cats or dogs.

When ringworm occurs in the scalp, it usually appears as enlarging patches of hair loss with a scaly scalp. It usually occurs in children 2 to 10 years of age. In advanced cases, the scalp can become quite swollen and pus pockets can develop in the scalp called kerion. This infection is usually transferred from other children and not from animals.

Treatment:

1. For ringworm of the skin apply Tinactin or Micatin cream (which do not require a prescription) twice a day until the rash has cleared.
   
2. Place the cream abut one inch beyond the red borders to make sure that you have killed all the fungus and continue the medicine for one week beyond the time it appears cleared.
   
3. You can treat your pets with the same medicine if you see ringworm on their skin.
   
4. The contagiousness with ringworm is so low that your child can go to school. However, after treating with an antifungal cream, go ahead and place a bandage over the area for one or two days.
   
5. For ringworm of the scalp, your child will need an oral antifungal agent prescribed and need to be treated for 6 to 12 weeks.
   
6. Use an antifungal shampoo such as Selsun twice a week and leave on the scalp for 10 minutes at each shampoo. This will reduce the contagiousness and allow your child to return to school.
   
7. It is unnecessary to shave your child's head when he has ringworm.
   
8. You will need to return to your doctor for a follow-up visit for the scalp ringworm, but not for ringworm of the skin.
   
9. Call your doctor if the skin ringworm is not looking better after one week or the scalp ringworm is getting larger two weeks after the oral medicine has been started.

SCABIES
[BACK TO LIST]

cabies is caused by the human itch mite, which is too tiny for most people to see with the unaided eye.  When one organism gets onto human skin, it burrows into the top layer of dead skin and lays eggs.  The eggs hatch in 5 days; those mites burrow in and produce more eggs. During this initial phase of reproduction a few hundred mites are produced and the human host experiences no itching or rash but is contagious to others.  Finally after 2 or 3 weeks the human becomes allergic to the mites and an itchy rash develops.  At the worst point of itching only a dozen or so mites are present, because the allergic response has already killed many of the mites.

The rash is usually extremely itchy, especially at night.  Dozens to hundreds of tiny bumps are present all over the body, with greater concentrations in the fold areas, such as finger webs, wrist folds, armpits, belly button, under the breasts, and between the buttocks.  There is often a rash on the nipples and genitals.  Older children and adults almost never have the rash above the neck and on the palms and soles, but infants frequently have the rash at those sites.  Some people have only a mild allergic reaction and develop only a few faint bumps with mild itching. Scabies mites are passed by skin-to-skin contact, usually among people sleeping together, and to children who are hugged and carried by adults.  Casual contact such as handshaking or contact in crowds does not pass the organism.  Mites live in the skin and do not come off easily, but occasionally an organism is shed into clothing or bedding where another human may contract it; such passage is rare, partially because the organism can survive off a human host for only a few hours. Treatment of scabies is simple and effective.  Children and adults apply a cream or lotion (prescribed by the doctor) to their entire skin surface below the neck.  Do not apply just to rash or itchy areas, and do not skip the buttock folds, genitals, toe webs or other difficult treatment areas.  The medication is applied at bedtime and washed off in the morning.  One or 2 treatments are adequate depending on the medication prescribed.  Bed partners should be treated simultaneously.  Infants may be given a different medication than the one used by adults; they should be treated on the face and scalp as well as elsewhere. Itching usually persists for a few days, or even up to 2 weeks after treatment, because it takes time for the allergic reaction to subside.  Your doctor may prescribe creams or pills to relieve the itching.  Do not increase your frequency of bathing or repeatedly use the antiscabies cream because that further irritates the skin and can increase itching.  If you think that you still have scabies or have reacquired it, you should return to the doctor for examination.

Simple precautions should be taken to prevent the spread of scabies in the home.  First, all occupants who are in intimate contact with each other should be treated at the same time (whether or not they are itching).  The morning after treatment the bed linen and night clothes should be washed, as well as the clothes which were worn the previous day.  No other clothes or furnishings need be cleaned.  Don't forget scabies mites survive less that 24 hours, so just setting aside difficult-to-clean clothing for 1-2 days ensures that it will be safe to use again.

SEIZURES WITH FEVER
[BACK TO LIST]

General Information:

rom the age of 6 months until 6 years of age children are susceptible to seizures (uncontrolled rhythmic shaking of the extremities) when they have high fever, usually greater than 103 degrees. These are quite common occurring in about one out of every 20 children and are the most common type of seizure. The seizures usually last about one to five minutes and while they scare the parents to death, they are virtually always harmless. The child is usually sleepy for several hours after the seizure. The fever can be caused by an infection in almost any area of the body and by both a bacterial infection or a viral infection.

About 60% of the children only have one febrile seizure in their life, but 40% will have two or more.  Normally physicians do not treat febrile seizures with seizure medication, but they will treat a bacterial cause of infection with antibiotics (for example, ear infections or strep throat) and also use anti-fever medicines such as acetaminophen and ibuprophen.

Treatment:

1. Reduce the fever by giving your child acetaminophen or ibuprophen. These may be alternated every two to three hours if your child's fever remains high. You may also give your child a tepid bath which will slowly bring down the temperature over 30-40 minutes.
   
2. During the seizure, try to keep your child's airway open. Children do not "swallow their tongue" during a seizure since the tongue is held into place by tissue underneath, but they can vomit and aspirate which can be serious. Turn your child on his side and clean out any contents of his mouth with your finger.
   
3. Do not try to restrain your child during the seizure; the seizure will end on its own.
   
4. Do not try to force anything into your child's mouth.
   
5. Call your doctor if this is the first febrile convulsion your child has had. Your doctor will probably want to exam your child to make sure that he does not need to be treated for an infection of some type.

Prevention:

1. Always try to have anti-fever medicines in your home to give to your child if she has a fever.
   
2. If your child has had a seizure before, always keep anti-fever medicines with you also.
   
3. Physicians do not normally give children anti-seizure medication for children who have had febrile seizures unless the child has had many because the medication would have to be given twice a day every day and they have significant side effects. It does not help to give seizure medicines only when a child has a fever because they take too long to begin working.

SINUS INFECTIONS
[BACK TO LIST]

General Information:

A sinus infection is a bacterial infection of one of the 7 sinuses that normally drain into the nose.  Sinus congestion can occur without an infection if one of the sinus openings becomes blocked from a cold or hay fever.  As bacteria multiply within the sinuses, pain and pressure occur above the eyebrow, behind the eye, or over the cheekbone. 

Sinus infections can cause lots of discharge, postnasal drip, fever, chronic cough, and bad breath.  Swallowing sinus secretions is normal and harmless but may lead to some nausea.  Yellow or green discharge does not guarantee a sinus infection since colds can also give you discolored discharge. Treatment should reduce pain and fever by 48 hours or less. Sinus infections are not contagious.  Your child can return to school or day care when she is feeling better and the fever is gone.

Treatment:

1. Antibiotics- This medicine will kill bacteria that are causing your child=s sinus infection.  Even though he will feel better in a few days, give all his medicine to prevent his infection from flaring up.
   
2. Decongestant Nose Drops or Spray- To drain her sinuses, use a long-acting nose spray such as Dristan Long Lasting Spray or its generic equivalent. This is a non-prescription medication. The usual dose for young children is 1 drop or spray each day.  Give her the medicine every day for the first 3 days of treatment.  Thereafter, do not give her the spray or nose drops unless her sinus congestion or pain recurs.  Stop her drops or spray for 2 days out of every 7 days to prevent rebound swelling (an artificial recurrence of her drainage and swelling due to sudden removal of her medicine)  from occurring.
   
3. Oral Antihistamines- If he has hay fever, give him an allergy medicine such as Benadryl, Dimetapp, Actifed, or Pediacare.  Otherwise, avoid antihistamines because they can slow the movement of his secretions out of his sinuses. 
   
4. Pain Relief Medicines.  Acetaminophen (Tylenol, Tempra, or generic) can be given to her for a few days for sinus pain or any fever greater than 102 degrees F (39 degrees C).

Call Your Doctor If:

1. Redness or swelling occurring on his cheek, eyelid, or forehead.
2. Her fever or pain is not gone after she has taken her antibiotic for 48 hours.
3. His yellow nasal discharge is not gone after 5 days.

SORE THROAT
[BACK TO LIST]

General Information:

Most sore throats are caused by viruses. The only bacteria which often causes sore throats in children is the streptococcus (the famous Astrep throat@). The only ways to accurately diagnose strep throat is to do a throat culture or a quicker (though slightly less accurate) 10-minute strep test. The culture usually takes 36 to 48 hours for results.

Strep throat is treated for 2 reasons:

• First, children will recover from symptoms more quickly (often dramatically) when given antibiotics.
• Second, treatment prevents complications such as rheumatic fever (a heart and arthritis disease) or nephritis (a kidney disease). It is important to treat strep throat for a full 10 days even though your child may feel fine in 2 days. Otherwise his strep throat may come back quickly or a secondary complication may occur in him.

Before the Culture Result is Back:

1. Treat her fever and pain with acetaminophen (Tempra, Tylenol, Panadol, or generic) or ibuprofen (Advil, Nuprin, Motrin, or generic). Fever often will continue for 12-24 hours after antibiotics have been started even if she has a strep throat.
   
2. Give him lots of cool fluids to cool his throat.
   
3. If your child is older, throat gargles or lozenges (Chloraseptic, Cepacol, Listerine, etc.) may help reduce her pain.

Call Your Doctor If:

1. He has trouble opening his mouth.
2. She develops difficulty breathing.
3. He suddenly looks more ill.
4. Her urine turns to the color of coke which might indicate nephritis.

After the Culture is Back:

1. Continue the above treatments.
   
2. If she has strep throat, give her the prescribed antibiotic for a full 10 days to prevent recurrence.
   
3. If his culture is negative, he has a viral sore throat or tonsillitis. No antibiotic will help him.  His own body will eliminate the virus after a few days.

SPITTING UP
[BACK TO LIST]

General Information:

Spitting up occurs commonly in young babies, but varies greatly in severity from baby to baby. It is seen more often when air is swallowed during feedings, thus being seen more with bottle feeding than with breast feeding. In its most severe form called gastroesophageal reflux, the cause is believed to be a weak ring of muscle guarding the entrance to the stomach. Almost all infants will outgrow the tendency to spit up by approximately 1 year of age.

Treatment:

1. Feed your baby before he becomes frantically hungry, avoid feeding him lying flat, and make feeding time calm and free from distractions.
   
2. Make sure the nipple hole is neither too small nor too big. Using a collapsible bottle (such as a Playtex Nurser) from which air may be expelled prior to feeding may be helpful.
   
3. Burp your baby frequently, after every 1 or 2 ounces of formula or 3 or 4 minutes of breast feeding.
   
4. Place your infant upright for 20-30 minutes after each feeding and avoid vigorous activity.
   
5. Elevate the head of her crib with blocks under the mattress (do not use a pillow in the crib). Place her to sleep on her side or back to reduce chances of Sudden Infant Death Syndrome.
   
6. Do not change your baby's formula on your own; certain formulas may decrease the amount that he is spitting up, but may not be nutritionally healthy for him.

Call Your Doctor If:

1. Your baby is vomiting, which in contrast to spitting up is quite forceful, large in quantity (most if not all of his feeding), and distressing to your baby.
2. She is spitting up and has frequent respiratory problems or failure to gain weight. In these circumstances, thickening her formula, giving her certain medications, or rarely, surgery, may be needed for her.
3. His spitting up is worsening or is associated with signs of illness in him such as fever,  diarrhea, cough, or fussiness.

SUNBURN
[BACK TO LIST]

General Information:
Sunburn is damage to the skin caused by the ultraviolet (UV) rays of the sun.  The pain and redness associated with sunburns do not usually show up until two or more hours after the exposure, increasing the likelihood of a severe sunburn, since you think the sun exposure is less. The full extent of the burn will not be seen until about 24 hours after sun exposure. Most sunburns are first degree burns which show up only as a redness of the skin. In severe cases one may have blistering and develop a second degree burn.

Repeated sun exposure even without burns can lead to premature aging of the skin manifested by early wrinkling, sagging, or brown spots.  Repeated sunburns are thought to dramatically increase the risk for skin cancers. The more routine types of cancers are rarely fatal, but the malignant melanoma which is also increased by repeated sunburns has about a 50% mortality rate.

Treatment:

1. Pain, which usually lasts for about 48 hours, can be relieved with acetaminophen (Tylenol, Tempra) or ibuprophen (Advil, Motrin) and cool baths or compresses.
2. Use a moisturizer preferably unscented, to restore moisture to the skin; do not use vaseline or ointments because they keep heat and sweat from escaping. Some people have found aloe vera gel helpful to cool the burning and reduce the extent of peeling.
3. Peeling will occur in about one week and is a good time to use more moisturizer.

Prevention:

1. Use sunscreen any time your child will be outside for more than 30 minutes at a time especially during late spring to early fall.
   
2. Increase the sun exposure time slowly in the spring so that your child can tan and thereby be protected from burning.
   
3. About 15% of Caucasians never tan (usually they have red hair or blond hair and blue or green eyes) and they especially need to wear sunscreen.
   
4. Infants skin is very thin and they should be protected by staying out of the sun or wearing protective clothing and a hat.
   
5. Stay indoors from 10AM to 3PM when the sun's rays are most direct.
   
6. Sunburns are common on cloudy days since 70% of the rays penetrate clouds.
   
7. Water, sand, and snow reflect sun rays increasing burns.
   
8. Sunglasses with ultraviolet protection will decrease cataracts later in life.
   
9. Use a sunscreen of SPF 15 (sun protection factor) or higher.
   
10. Place the suncreen on 30 minutes before going outside to allow it to penetrate into the skin and pay special attention to high exposure areas such as the nose, ears, cheeks, and shoulders. Reapply every 3 to 4 hours.
    
11. Do not put first aid creams or sprays on your child's skin since they contain benzocaine that can cause an allergic rash.
    
12. Call your doctor for eye pain, fevers, or signs of infections.

SWIMMER'S EAR
[BACK TO LIST]

General Information:

wimmer's ear is caused by prolonged wetness of your child's ear canal.  This most commonly occurs in older children who swim every day during the summer.  It does not usually result from getting water in your child's ear from baths or showers. The only reason you should be concerned about your infant or young child getting water in her ear during bath time is if she has tubes in her ears. The tubes provide a passage way to the middle ear and bath water can cause a middle ear infection under those circumstances.

Swimmer's ear causes a dull aching pain in your child that becomes severe when his ear is bumped or his ear lobe is pulled.  No fever or other impressive symptoms occur elsewhere in his body.

Treatment:

1. She should not swim for at least 1-2 weeks.
   
2. Use the prescribed ear drops in his ears for about 1 week.
   
3. If her case is particularly severe, an oral antibiotic may be prescribed.
   
4. His symptoms tend to resolve slowly over several days to a week.
   
5. Acetaminophen (Tempra, Panadol, Tylenol, or generic) or ibuprofen (Advil, Motrin, Nuprin, etc.) should be given to her for pain especially at night.

Prevention:

After swimming, do the following:

1. He should tilt his head to each side and thump it to get excess water to drain.
   
2. Make a mixture of white vinegar and alcohol in equal parts ( 1 ounce of vinegar and 1 ounce of alcohol) and place several drops in both her ears after swimming. This kills bacteria and dries out her ear canals.
   
3. If he has a burning sensation when you place this mixture in his ears, he should stop swimming and stop using the alcohol/vinegar mixture for several days.  Restart the alcohol/vinegar mixture in 3-4 days.  If he has the burning again, then call the office for prescription drops to treat him for swimmer's ear.