Friday, April 28, 2006

Poison Ivy

Dear Lisa

My 11 year old son gets Poison Ivy every summer. Is there anything I can do to prevent him from getting it?

“Don’t want the itch in N.J.”

Dear “Don’t want the itch”,

Poison Ivy is an allergic skin reaction that children develop after being exposed to Poison Ivy, Poison Oak or Poison Sumac. Any part of the plant, including the twigs, roots, leaves and resin can cause a reaction. The best prevention is to familiarize yourself and your child with the offending plant and stay away from it. The Poison Ivy plant has three notched leaves and grows as a tall shrub or rope like vine. Hence the phrase, “Leaves of three, let them be.” Poison sumac grows as a shrub or tree and has 7 to 13 leaflets arranged in pairs along a central stem with a single leaflet at the end. It grows in woody or swampy areas. Poison oak grows as an upright shrub or tree and is most prominent on the west coast of the United States.(1) If you have Poison Ivy, Oak or Sumac on your property, have it removed in order to cut down the risk of exposure.

If your child is exposed, have him wash with warm soapy water immediately. Remember to wash or discard any other items that came into contact with the plant too; such as clothes, sneakers, toys or athletic equipment. A mixture of cold water and rubbing alcohol will help remove the resin from such equipment. The resin from the plant can be very sticky and remain on objects for a very long time. Your child can be exposed at a later date if contaminated objects are not washed right away. Good Luck!

(1) Hurwitz, S. Clinical Pediatric Dermatology. Pennsylvania: Saunders company, 1993.

Lisa Kelly, P.N.P., C.
Certified Pediatric Nurse Practitioner

Advice for Parents- Keeping your child healthy

Thursday, April 27, 2006

Asthma Triggers

Dear Lisa

My 10 year old son has Asthma. I bring him to the Doctor regularly and he takes the medication prescribed. His Asthma symptoms come on out of the blue, for no apparent reason. Are there any measures I can take to prevent him from having attacks?

“Want to prevent Asthma Attacks in N.J.”

Dear “Want to prevent Asthma Attacks",

Asthma is a chronic inflammatory disorder of the airways which leads to reversible airway obstruction. Although Asthma is a chronic disease, it seems to present with periods of exacerbations and remissions. The exacerbations are typically brought on by an Asthma “trigger”. The exposure to Asthma triggers may lead to worsening of a child’s condition.

The common triggers for Asthma include, infections (such as a virus, or a sinus infections), allergies, irritants(such as cigarette smoke or perfume), poor air quality, weather (especially weather changes), exercise, hormonal changes, medications (such as aspirin, ibuprofen or heart medications), stress and strong emotional expression (such as laughing or crying hard). Not everyone with Asthma has the same triggers and some people only develop symptoms if they are exposed to more than one trigger at a time.

You seem to be on the right track because your child sees the Doctor regularly and takes the medication as prescribed. I believe one of the most effective ways of preventing Asthma exacerbations is to identify and control your child’s triggers. If you do not know your child’s triggers, I suggest keeping a diary of all exacerbations. In the diary, include your child’s activity, exposures, location, the weather and environment, the date, diet, medications and state of health.

Upon reviewing the diary you may find a pattern which will help you identify his triggers. For example, some children with Asthma will only have an attack if they run outside in the very cold air when they have an upper respiratory infection. Another child may only have a problem when they sleep over a friend’s house that has pets.

If you have trouble identifying and controlling your child’s triggers or if his symptoms seem to becoming more frequent or out of control, I suggest that you bring your child to an Asthma Specialist for an evaluation. I applaud you for trying to gain better control over your child’s Asthma and wish you success in your endeavor.

Lisa Kelly, R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice- Your Questions Answered

Wednesday, April 26, 2006

Belly Button Infection

Dear Lisa

My two week old baby’s umbilical cord came off today. I noted some streaks of blood. Is this normal? Could it be infected?

“Worried about my baby's belly button ” in N.J.

Dear “Worried about my baby's belly button”,

A newborn baby’s umbilical cord usually falls off between 2 to 3 weeks of life. When it initially falls off it is normal to have a few streaks of blood. It would not be normal if there was continuous oozing of blood because blood should clot within a few minutes. If this was the case, then you would need to see your doctor right away.

The signs that a baby has “omphalitis” or an infection of the umbilical cord (belly button) include; foul smelling discharge, redness of the skin around umbilicus (belly button), fever, problems feeding or irritability. If your child has any of these symptoms it would be wise to bring him in to your health care provider for an evaluation.

Lisa Kelly, R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Advice for Parents Updated Daily

Tuesday, April 25, 2006

Cradle Cap

Dear Lisa

I just had my third child. My other two children didn’t have cradle cap and this one does. What is it from and how can I get rid of it?

“Cradle Cap” in New York

Dear “Cradle Cap”

Cradle Cap is a build up of dead skin cells over the anterior fontanel of an infant. Many parents are reluctant to wash this “soft spot” when bathing their child and as a result a build up of crust develops. In order to get rid of cradle cap, gently rub baby oil into the child’s scalp, concentrating on the “soft spot”. Let the baby oil stay on for 20 minutes. Take a fine tooth baby comb and carefully comb out the crust.

Following this, wash the baby’s scalp with a dandruff shampoo, such as Sebulex. Rarely will cradle cap be resolved after one treatment. Generally this procedure needs to be repeated 4 to 5 times (waiting 2 to 3 days between treatments) before the scalp is clear from cradle cap. In order to prevent cradle cap from reforming, shampoo the baby’s scalp twice per week while gently massaging the soft spot with each shampoo.

Lisa Kelly, R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily

Monday, April 24, 2006

MMR Vaccine

Dear Lisa

My daughter is 2 years old and is going to the Pediatrician’s office next week for her MMR vaccine. I am worried about the side effects. What are the side effects?

“Worried about the MMR in N.J.”

Dear “Worried about the MMR”,

For most children the MMR vaccine causes few or no problems. The common side effects include fever and rash which usually occurs 6 to 12 days after receiving the MMR. Other rare side effects include transient thrombocytopenia and seizures. Thrombocytopenia is a decrease in the platelet count which may put one at risk for bleeding because platelets are needed for blood clotting. The Red Book reports the incidence of thrombocytopenia to be 1 per 2 million doses distributed in the United States. Studies have suggested that an increased risk of seizures after administration of measles containing vaccines to children who already have a history of seizures in their past or whose first degree family members have a history of seizures.

In my experience, most children do not have a problem with the shot. Occasionally a parent may complain that their child developed a rash which looked like a few dots on their belly or pain and swelling at the injection site. As the case with any vaccine, an allergic reaction to any of the components is also a risk. If you are worried about the MMR vaccine, you should discuss this with your Pediatrician who can provide you with more information and literature.

Lisa Kelly, R.N., P.N.P. ,C.
Certified Pediatric Nurse Practitioner

Free Pediatric Advice Updated Daily

Sunday, April 23, 2006

Baby Acne

Dear Lisa

My 4 week old infant has pimples all over his face. I’ve been treating him with a baby lotion that I have. Is this okay? “Why do babies get pimples?”

“Baby acne in N.Y.”

Dear “Baby Acne”,

Acne neonatorum or “baby acne” affects approximately 20 % of all newborn infants. It is defined as inflammatory pustules scattered predominantly over the cheeks and occurs during the first few weeks of life. Baby acne may be present at birth and in some cases may spread to the infant’s neck and chest. Many parents report that it appears worse right after the baby’s bath. Baby acne is caused by hyperactive sebaceous (sweat glands) which are stimulated by androgens (hormones). The best treatment for neonatal acne is to leave it alone. All you need to do is wash the baby’s face with a soft wash cloth and water. In most cases the acne should clear by 6 to 8 weeks old on its own. Some health care providers may recommend the application of Benzoyl peroxide if the acne is severe. If your baby’s rash is persistent or worsening contact your Pediatrician or Nurse Practitioner in order to rule out other diagnoses.

Lisa Kelly , R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily

Saturday, April 22, 2006

Stubborn Splinter

Dear Lisa

My 4 year old son got a splinter in his foot. Whenever he gets a splinter and I try to take it out, he wiggles and cries so much that it’s almost impossible to even see what I’m doing. Do you have any suggestions on getting splinters out?

“Can’t Get The Splinter Out” in N.J.

Dear “Can’t Get The Splinter Out”,

First make sure it really is a splinter. I had a little girl come into the office once with her mom complaining about a splinter in her heel and it turned out to be a straight pin! If you’re sure it is a splinter, I do have a few hints for you. If you soak the area first, it softens the skin and makes the splinter come out easier. Put warm soapy water with a couple of squirts of Betadine solution (if you have it) into a small bowl and have your child soak his hand or foot for 10 to 15 minutes. Next wipe the area with a cotton ball soaked in Hydrogen Peroxide a few times (this is not recommended if the splinter is on the face). The hydrogen Peroxide will bubble at the site of entry and therefore you will know where the opening in the skin is and where to pick. The Hydrogen Peroxide breaks down skin and will cause the skin above the splinter to peel, exposing the splinter and therefore allowing it to come out more easily. Next, invest in a really good pair of tweezers with a pointy tip. The right equipment makes a world of difference. One suggestion to relieve the pain is to press firmly with your finger on the area below the splinter during the removal process. By doing this your child will feel the pressure from your finger and the splinter site will hurt less.

For children who really are out of control, one suggestion is to remove the splinter at night when the child is sleeping. Make sure you have permission from your child to do this. If your child has had a bad experience in the past with splinters, chances are he or she will happily agree to this. If the splinter is deep, appears infected or you are not able to get it out, you should contact your Doctor or Nurse Practitioner. Good luck!

Lisa Kelly, R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Website

Friday, April 21, 2006

Chicken Pox

Dear Lisa

My 6 year old daughter is in Kindergarten and I received a notice from her school that one of her classmates developed Chicken Pox. How could this be? I thought that all children in school are immunized for Chicken Pox. My child received the vaccine, does this mean that she can get the chicken pox too?

Don't want Chicken Pox - N.J.

Dear "Don't Want Chicken Pox",

Yes, most states recommend that children receive the Chicken Pox Vaccine (Varicella) before entering kindergarten and New Jersey is one of them. Even if a child is immunized with the Chicken Pox Vaccine, they may contract a milder form of the disease. A milder case usually includes scattered lesions or pox (compared to 500 or more pox in naturally acquired disease), a mild sore throat and a sometimes a low grade temperature. A mild case usually only lasts for a few days, as compared to a full blown case of chicken pox which lasts approximately 2 weeks.

Some parents argue that they don't want the Chicken Pox Vaccine if there is a chance that their child can still get Chicken Pox. The reason why the vaccine is recommended is that it dramatically reduces the chances of severe disease and its complications. Research studies show that the Varicella vaccine is almost 100% effective against severe Varicella disease (New England Journal of Medicine. 2001;344).

In regards to the question, "Is my child going to get Chicken Pox?" Generally there is a 10 to 15% chance that your child will get Chicken Pox if she is vaccinated.

I wish you well.

Lisa Kelly, R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Infectious Diseases

Thursday, April 20, 2006

Ear Infection

Dear Lisa

My 15 month old daughter had a stuffy nose and was waking at night. I brought her to the Pediatrician's office and he told me that she had an ear infection. I gave the Amoxicillin that was prescribed. I'm worried because she's been on the antibiotic for four days, and now she started to wake at night again. Today she's very cranky, her nose is more stuffy than before and now she has a fever of 101. I have to go to work tomorrow and I'm not sure if I should take off work and take her back to the doctor. She's already on an antibiotic, so what else is he going to do?

Don't know what to do- N. J.

Dear "Don't Know what to do",

Since your daughter seems to be getting worse I would bring her back to the doctor's office. Viruses are very common in young children and are not responsive to antibiotics which treat bacterial infections. It is possible that she developed a virus even though she is on an antibiotic. Sometimes children develop an additional infection when their body is under stress. For example, a urinary tract infection may develop along with an ear infection. Urinary tract infections are hard to diagnose in young children because they do not present with the classic symptoms. Another possibility is that your child's ear infection may not be responsive to Amoxicillin. Some children, especially those in daycare settings, develop resistant organisms that cause ear infections which may not be responsive to Amoxicillin. Your daughter's situation deserves an evaluation by your Pediatrician and I'm sure that your day off work will be well spent.

Lisa Kelly, R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Ask Lisa - Pediatric Advice Updated Daily

Wednesday, April 19, 2006

Problem Focusing

Dear Lisa

I know I'm not supposed to compare my children to each other, but I can't help it. My 11 year old son is so difficult compared to my other two younger children. He can't seem to follow directions. All I have to say is get ready for bed and my other two children get their pajamas on and brush their teeth without a problem.

My oldest son can't seem to stay on task. An hour later, his pajamas are still not on. Forget about homework time. He comes home from school with papers all over the place, always forgets one of his books, and he doesn't remember his homework assignments. Doing homework is a nightmare. I have to tell him 100 times to do his homework and hours later it's still not done. I can't help but think there is something wrong with him.

"At the end of my rope- N.J."

Dear "At the end of my rope",

The first step is to talk to your son's Pediatrician or Nurse Practitioner about your concerns. They will be able to rule out any physical reason why your child doesn't seem to listen. Once a physical cause is ruled out you can ask your Pediatrician for a referral to a Neurodevelopmental Specialist or contact the Child Study Team at your child's school so your child can have a thorough evaluation.

There are some children with Attention Deficit Disorder (ADD) who do not necessarily have problems with hyperactivity but instead have a lot of issues with focusing and problems staying on task. There are also learning disabilities which present themselves with the same type of symptoms. Rather than try to punish your son for something he may not be able to control, I would investigate the reasons behind his behavior. A proper diagnosis will put you and your son on the right road, help you better understand his actions and give you the tools you need to address the problem.

I wish you well.

Lisa Kelly, R.N., P.N.P.,C.
Pediatric Nurse Practitioner

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Tuesday, April 18, 2006

Painful Earlobes

Dear Lisa

My daughter told me that her earrings hurt. When she showed them to me, I saw that her earlobe was red, swollen and there was some crusty discharge. I took the earrings out. Should I leave them out? What can I do to help her earlobes heal?

"Painful earlobes in N.J."

Dear "Painful Earlobes",

It is common to develop Contact dermatitis, or a skin reaction due to earrings. It can occur due to metal sensitization. Nickel is the most likely culprit, although other metals such as cobalt, and chromium have been implicated as well. Direct skin contact with any object that releases nickel carries a risk of causing contact dermatitis. (1)

Since your child also has pain and crusty oozing the site may have become infected from touching. Most jewelers will give you a bottle of cleaning solution to put on the piercing site when you get your ears pierced. If you don't have this lotion you can clean her earlobes with rubbing alcohol or hydrogen peroxide (hydrogen peroxide will burn less, but might make the skin peel a little).

Following this, you can apply an over-the-counter antibacterial ointment such as Neosporin. You can put a small amount of Neosporin on the posts of a different pair of earrings (preferable gold studs) and insert them in her earlobes. It is recommended that jewelry infections at the site of deep puncture piercing be left in place to allow drainage to continue and to prevent abscess formation. (2) Just in case her earlobes are infected you can clean them daily and apply an antibiotic ointment twice per day. If they are not infected this will prevent them from becoming infected.

Your daughter should wash her hands frequently and try not to touch her ears. If your daughter's symptoms persist despite your treatment or if the redness and/or swelling spreads bring her in for an evaluation to your Doctor or Nurse Practitioner.

Oh, the price we pay for beauty!

(1)Larzo MR, Grimm P. Adverse Consequences of Tattoos and Body Piercings. Pediatric Annals. 2006;35(3):187-192.
(2)Koenig LM, Carnes M. Body Piercing: Medical concerns with cutting edge fashion. J Gen Intern Med. 1999;14(6):379-385.

Lisa Kelly, R.N., P.N.P.,C.
Pediatric Nurse Practitioner

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