Monday, April 28, 2014

Cradle Cap and Seborrheic Dermatitis

     Seborrheic dermatitis is a skin condition with red patches that can be divided into two types: cradle cap (infants) and seborrheic dermatitis (older children and adults). For infants, it will often start within the first month or two of birth and last until the infant is somewhere between 6-12 months of age. Older children that develop this find it happens late in or after puberty. There is a genetic component: it does tend to run in families.
     "Seborrheic" means "runny or seeping oil" and the rash is often accompanied by yellowish oily film or scaly crust. The rash in infants is most often just on the forehead, but there may be a rash in many other areas. This rash may be red and in splotchy areas or be many fine small "pimple" looking spots. There may be an oily or crusty appearance to the top of the smaller rashy areas. Seborrheic dermatitis can be itchy but is not always.
     What to do if your child has cradle cap? For infants where there is not much cradle cap and it does not cause your infant to scratch at the area, it is fine to just watch. The first step in treatment is to massage baby oil into the area 20-30 minutes before a bath. Then wash the hair with the usual baby shampoo that you use. After the bath, gently brush at the area with a soft-bristled brush. Do this regularly (2-3 times a week or more) until the cradle cap improves and the flakes are removed. Then repeat as needed in future weeks. Remember that the baby oil will not cure the cradle cap, just keep it calmed down until the cradle cap improves as the months go by.
     For those infants and children that the baby oil and brushing is not effective, we recommend trying using one of the over the counter medicated shampoos: Head 'n' Shoulders, Selsun Blue, or Neutragena T-Gel. Note: these are the same ones you and I would use. They do not make "infants" or "kids" forms of these. All of these can sting the eyes so be cautious about rinsing them out while keeping them out of the eyes (tilt the head back and pour the water front to back). These shampoos can be used daily or a couple times a week. If the cradle cap improves over a couple weeks, you may just need to use the medicated shampoo once a week. The baby oil can still help get the oily scales off the scalp.
     Most of the infants are not itchy with the cradle cap. However, for those infants that are itchy and the above measures are not helping, it can really help to use the over the counter 1/2-1% hydrocortisone cream (such as "Cortaid"). Apply a thin layer to the cradle cap once or twice a day. Ideally, this is only done when the itching is bad and for 3-7 days then off for the same amount of time.
     For older children with dandruff, itching, and seborrheic dermatitis, we recommend they use one of the three shampoos (Head 'n' Shoulders, Selsun Blue, or Neutragena T-Gel). If using that on a regular basis does not help, we can discuss here in the office -- there are prescription strength shampoos that can really help. If despite even the prescription medication your child's medication is no better, we would have them see a dermatologist.

Monday, April 21, 2014

Water Safety and Swimming Lessons

    The American Academy of Pediatrics found for many years that it was difficult to answer the question of "Is my child less likely to drown if they have taken swim lessons?". That might seem like the answer would be "Of course they are safer if they have had swim lessons." However, for a long time, it was not known for sure if that was true. And a long time worry has been whether parents and guardians could drop their guard about the child swimming if the parent and guardian knew that the child had swimming lessons.
     Here is the Healthy Children's website about drowning prevention and swim safety. And here is another good webpage about the same subject. From the same website, here is an audio piece to listen to about infant and toddler swimming lessons. One last link -- this directly from the American Academy of Pediatrics.
     So I do think swim lessons are fine for young toddlers. Formal swim lessons for children 4 years of age and above are a good idea. BUT never let your guard down. Even with good swimmers. Do not assume someone else is supervising your child while they are in the water.

Tuesday, April 15, 2014

2014 Mumps Outbreak in Central Ohio

     Mumps is a viral infection that causes swelling of one or more of the saliva (spit) glands, usually the parotid glands (in your cheeks in front of the ears). About one of three cases of mumps show no obvious symptoms. Mumps can cause swelling of the testes, ovaries, or breast tissue one week after the parotid gland swelling. These are more common with young adults and adults with mumps. Mumps rarely causes much in the way of cough, runny nose, and congestion. It commonly causes achiness, low grade fever, tiredness, and decreased appetite. Mumps is spread person-to-person by sharing cups, utensils, kissing, etc. Children with mumps are contagious for a few days ahead of the symptoms starting and 5 days after the swelling of the parotid glands.
     The vaccine for prevention of the mumps became available in the 1960s and by 1977 was a routine part of the vaccine schedule in the United States. Since then, the chances of getting mumps in this country has plummeted to a low "normal" of 200-300 cases across the country each year. In some years there have been as many as 1000-6000 cases, especially amongst college students. Although those children and adults who are not vaccinated are more prone to develop the mumps, in outbreaks many of those that develop have been vaccinated. The vaccine provides very good but not perfect protection.
     Because of the success of the vaccine, we have never had a confirmed case of the mumps seen by Hilliard Pediatrics. That continues to be true as April 15, 2014 -- despite the recent outbreak in Central Ohio. Currently the recommendation is to not change anything about the timing of the two mumps vaccines -- giving in combination with the measles and rubella vaccines at 12 months of age and 5 years of age. Although the recommendation would be for those with just one MMR vaccine and past the age of 5 years to receive a second dose now, no other recommendations are made at this time.
     We do want to see children with symptoms that could be mumps. There is testing available that can confirm that it indeed is mumps. The symptoms of sore throat and fever are treated, but generally the illness passes on its own without other complications.
     Keep vaccinating your children.

     UPDATE: As of May 21, 2014, we do have a teenager in the practice that we are highly suspicious that he has mumps. He attends a Hilliard high school.

As of May 30, 2014, we have now seen two cases of mumps. Initially, the lab work to confirm that it was mumps was paid for the CDC or NIH. Now it is not. And the testing costs as much as $400-600 and takes 10-14 days to come back. So we are not gong to routinely test to confirm that the cases we see are indeed the mumps.