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SKIN
Definition
Pimples and blackheads on the face caused by blocked oil glands
Symptoms of Acne
Whiteheads (pimples) are plugged oil glands that are closed.
Blackheads are plugged oil glands that are open. Reason: The oil turns black when it is exposed to air.
Whiteheads and blackheads are also called "zits."
Red bumps are from blocked oil glands that have leaked oil. This causes irritation in the skin around them. Larger red bumps can be quite painful.
Acne mainly appears on your face, neck, and shoulders
Causes of Acne
Acne skin changes are from plugged oil glands. Acne has several causes.
Increased levels of hormones during puberty have a part. Heredity also plays an important role.
Some skin bacteria can make it worse.
Acne is not caused by diet. You do not need to avoid eating fried foods, chocolate, or any other food.
Acne is not caused by dirt or by not washing your face often enough.
Call Doctor or Seek Care Now
Spreading red area around the acne with fever
Spreading red area or streak that's very large
Your child looks or acts very sick
Call Doctor Within 24 Hours
Spreading red area or streak around the acne, but no fever
You think your child needs to be seen
Call Doctor During Office Hours
Tender red lumps that are large occur
Yellow soft scab that drains pus or gets bigger occurs
After treating with Benzoyl Peroxide (BP) for 2 months, acne not improved
BP makes the face itchy or swollen
You have other questions or concerns
Self Care at Home
Mild acne
Care Advice
What You Should Know About Acne:
More than 90% of teenagers have some acne. Acne is a normal part of the teen years.
There is no medicine at this time that will cure acne.
However, good skin care can keep acne under control and at a mild level.
Here is some care advice that should help.
Benzoyl Peroxide Gel:
Benzoyl Peroxide (BP) is the best OTC medicine for bringing acne under control. Use a Benzoyl Peroxide 5% gel product (such as the store brand). OTC means no prescription is needed.
It helps to open pimples and to unplug blackheads. It also kills bacteria.
Apply the lotion once a day at bedtime to the area with acne. Redheads and blonds should apply it every other day for the first 2 weeks. Reason: More sensitive skin.
Use an amount of lotion the size of a pea. This should be enough to cover most of the acne.
If the skin becomes red or peels, use less of it. Other option: You can use it less often.
Caution: Avoid the corners of the eyes, nose and mouth. Reason: These areas are very sensitive.
Caution: Benzoyl Peroxide bleaches clothing, towels, blankets, etc. Apply it only at bedtime and put it on sparingly. Use a plain white pillowcase.
Antibiotics for Red Bumps:
Large red bumps mean the infection has spread beyond the oil gland. If you have several red bumps, your doctor may prescribe an antibiotic.
Antibiotics come as solutions for the skin or as pills.
The antibiotic will kill the bacteria that are causing the infection.
Give the antibiotic as directed.
Washing the Face:
Wash your skin twice a day. The most important time to wash is bedtime. Just use warm water or you can use a mild soap (such as Dove).
Shampoo your hair daily.
Avoid scrubbing your skin. Reason: Hard scrubbing of the skin irritates the openings of the oil glands. This causes them to close off even more tightly.
Pimple Opening:
Opening (popping) pimples is not advised by many doctors. But, most teens and adults do it anyway.
So, here's how to open a pimple safely without any squeezing.
Never open a pimple before it has come to a head.
Wash your face and hands first.
Use a sterile needle (cleaned with rubbing alcohol). Nick the surface of the yellow pimple with the tip of the needle. The pus should run out without squeezing.
Wipe away the pus and wash the area with soap and water.
Opening small pimples in this way will not cause skin damage.
Avoid Picking or Squeezing Acne:
Many young people pick at their acne when they are not thinking about it. Picking makes acne worse.
Try not to touch the face at all during the day.
Squeezing blackheads causes bleeding into the skin. The bleeding turns into brownish blotches on the skin. They can take 1 or 2 months to fade.
Squeezing red lumps can force bacteria into the skin. This too leaves blotches. It can also cause a serious face infection.
Prevention - Avoid Triggers of Acne:
Avoid putting any oily or greasy substances on your face. Reason: They block oil glands and make acne worse. If you use cosmetics, use water-based cosmetics.
Avoid hair tonics or hair creams (especially greasy ones). When you sweat, they will get on the face and irritate the acne.
What to Expect:
With treatment, new whiteheads and blackheads will decrease. But, it takes 6 to 8 weeks.
Acne usually lasts until age 20 or 25.
So, you will need to continue the treatment for several years.
You don't need to worry about scarring. It is very rare for acne to leave any scars.
Call Your Doctor If:
With treatment, the acne has not improved after 2 months
It looks infected (large, red, tender bumps)
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Bite from a pet, wild animal or human
Types of Wounds
Bruise. There is no break in the skin. No risk of infection.
Scrape (Abrasion) or Scratch. A wound that doesn't go all the way through the skin. Low chance of infection. Antibiotic drugs are not needed.
Cut (Laceration). A wound that goes through the skin to the fat or muscle tissue. Some chance of infection. Most need to be seen. Cleaning the wound can help prevent this. Antibiotic drugs may be needed.
Puncture Wound. These wounds break through the skin. Greater risk of infection. Puncture wounds from cat bites are more likely to get infected. Antibiotic drugs may be needed.
Wound Infection. This is the main risk of an animal bite. The main finding is redness around the bite and pain. It starts 8 hours to 3 days after the bite. It can often be prevented by early, careful cleaning of the bite. This is why most animal bites need to be seen.
Types of Animal Bites
Large Wild Animal Bites. Rabies is a disease that can kill people. Bites or scratches from any large wild animal can pass on rabies. Animals at highest risk are bats, skunks, raccoons, foxes, or coyotes. These animals may spread rabies even if they have no symptoms.
Small Wild Animal Bites. Small animals such as mice, rats, moles, or gophers do not carry rabies. Chipmunks, prairie dogs, squirrels and rabbits also do not carry rabies. Exception: one of these small animals actually attacks a human (an unprovoked bite). Sometimes, their bites can get infected.
Large Pet Animal Bites. Most bites from pets are from dogs or cats. Bites from other pets such as horses can be handled using this guide. Dogs and cats are free of rabies in most U.S. and Canadian cities. Stray animals are always at risk for rabies until proven otherwise. Cats and dogs that always stay indoors should be safe. The main risk in pet bites is wound infection, not rabies. Cat bites become infected more often than dog bites. Cat scratches can get infected just like a bite because cats lick their claws.
Small Indoor Pet Animal Bites. Small indoor pets are not at risk for rabies. Examples of these pets are gerbils, hamsters, guinea pigs, or mice. Tiny puncture wounds from these small animals also don't need to be seen. They carry a small risk for wound infections.
Human Bites. Most human bites occur during fights, especially in teenagers. Sometimes a fist is cut when it strikes a tooth. Human bites are more likely to become infected than animal bites. Bites on the hands are at higher risk. Many toddler bites are safe because they don't break the skin.
Bat Bites and Rabies. In the U.S., 90% of cases of rabies in humans are caused by bats. Bats have spread rabies without a visible bite mark.
Animals at Risk for Rabies
Bat, skunk, raccoon, fox, or coyote
Other large wild animals
Pets that have never had rabies shots and spend time outdoors
In the U.S., rabies occurs 4 times more in cats than in dogs.
Outdoor animals who are sick or stray
Dogs or cats in countries that do not require rabies shots
In the U.S. and Canada, bites from city dogs and cats are safe.
In the U.S., there are 2 - 3 deaths from rabies per year in humans.
When To Call
Call 911 Now
Major bleeding that can't be stopped
Not moving or too weak to stand
You think your child has a life-threatening emergency
Go to ER Now
Bleeding that won't stop after 10 minutes of direct pressure
Any scratch or cut from an animal at risk for Rabies
Call Doctor or Seek Care Now
Wild animal bite that breaks the skin
Pet animal (such as dog or cat) bite that breaks the skin. Exception: minor scratches that don't go through the skin.
Puncture wound (holes through skin) from a Cat's teeth or claws
Puncture wound (holes through skin) of hand or face
Human bite that breaks the skin
Bite looks infected (redness or red streaks) or has a fever
Bat contact or exposure, even without a bite mark
Contact with a rabies-prone animal, even without a bite mark
Minor cut or scrape and no past tetanus shots
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Last tetanus shot more than 5 years ago
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Bite did not break the skin or is only a bruise
Minor scratches that don't go through the skin from a pet
Tiny puncture wound from small pet, such as a hamster or puppy. Exception: cat puncture wound.
Care Advice
What You Should Know About Bites:
Bites that don't break the skin can't become infected.
Cuts and punctures always are at risk for infection.
Here is some care advice that should help.
Clean the Bite:
Wash all wounds right now with soap and water for 5 minutes.
Also, flush well under running water for a few minutes. Reason: Can prevent many wound infections.
Bleeding - How to Stop:
For any bleeding, put pressure on the wound.
Use a gauze pad or clean cloth.
Press for 10 minutes or until the bleeding has stopped.
Antibiotic Ointment:
For small cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed.
Put it on the cut 3 times a day.
Do this for 3 days.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Cold Pack for Pain:
For pain or bruising, use a cold pack. You can also use ice wrapped in a wet cloth. Apply it to the bruise once for 20 minutes. Reason: Helps with bleeding, pain and swelling.
What to Expect:
Most scratches, scrapes and other minor bites heal up fine in 5 to 7 days.
Call Your Doctor If:
Bite starts to look infected (pus, redness, red streaks)
Fever occurs
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
An itchy rash of the feet and between the toes
Skin infection caused by a fungus
Age over 10 years
Symptoms of Athlete's Foot
Red, scaly, cracked rash between the toes
The rash itches and burns
With itching, the rash becomes raw and weepy
Often also involves the insteps of the feet
Unpleasant foot odor
Mainly in teens. Before age 10, it's usually something else.
Cause of Athlete's Foot
A fungus infection that grows best on warm, damp skin
Other health problems of Athlete's Foot
Jock Itch. A fungus infection of the groin and inner, upper thighs. Caused by the same fungus that causes athlete's foot. Transferred by a towel used to dry the feet and then the groin.
Impetigo. A local bacterial infection that starts in the cracks between the toes. Gives sores, soft scabs and pus.
Cellulitis. The bacterial infection spreads into the skin. Gives redness spreading into the back of the foot. The red area is painful to the touch.
Lymphangitis. The bacterial infection spreads up the lymph channels. Gives a red line that goes up the leg. More serious because the infection can get into the bloodstream. This is called sepsis.
When To Call
Call Doctor or Seek Care Now
Fever and looks infected (spreading redness)
Call Doctor Within 24 Hours
Looks infected and no fever
Pus drains from the rash
Foot is very painful
Call Doctor During Office Hours
You think your child needs to be seen
Rash has spread to the top of the foot
Age less than 10 years
Rash is not better after 1 week on treatment
Rash not gone after 2 weeks on treatment
You have other questions or concerns
Self Care at Home
Mild athlete's foot
Care Advice
What You Should Know About Athlete's Foot:
Athlete's foot is common in teens.
It's caused by a fungus that grows best on warm, damp skin.
Here is some care advice that should help.
Anti-Fungal Cream:
Use an anti-fungal cream (such as Lotrimin). No prescription is needed.
Use 2 times per day.
Put it on the rash and 1 inch (25 mm) beyond its borders.
Continue the cream for at least 7 days after the rash is gone.
Keep the Feet Dry:
Rinse the feet 2 times per day before using the cream.
Go barefoot or wear sandals as much as possible.
Wear socks made of man-made fibers. They will keep the feet drier and cooler than cotton. Change them twice daily.
Do Not Scratch:
Scratching infected feet will delay a cure.
Rinse the itchy feet in cool water for relief.
Return to School:
Athlete's foot is not easily spread to others. The fungus can't grow on dry, normal skin.
Children with athlete's foot do not need to miss any school. Your child may take gym and play sports.
The socks can be washed with the normal laundry. They don't need to be boiled.
Jock Itch Prevention:
The athlete's foot fungus can spread to the groin area. This is called jock itch.
The fungus can be spread by a towel or washcloth.
Therefore, after bathing, dry the groin area before the feet.
You can also use a different towel for the feet.
Do this until the athlete's foot is cured.
What to Expect:
With proper treatment, athlete's foot goes away within 2 weeks.
Call Your Doctor If:
It looks infected
Rash is not better after 1 week on treatment
Rash is not gone after 2 weeks on treatment
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Bites from bed bugs
Symptoms of Bed Bug Bites
Usually cause itchy, red bumps in a group or line
Often they look like a hive or mosquito bite
Bite may have a red dot (puncture) in the center. This is where the bed bug bit through the skin.
Occasionally, a small blister can occur in the center
Bites are usually on exposed skin (arms, legs and face)
Bites are usually first noted in the morning
Diagnosis of Bed Bug Bites
Live bed bugs hide and are not usually seen. Close inspection of the mattress may find some.
They are ¼ inch (6 mm), flat, oval shaped, reddish-brown bugs.
Suspect bed bugs if over 3 red bumps in a row are on exposed skin. The bumps or bites are very itchy.
Bed bug waste is found on bedding or mattress seams. It looks like dark brown flecks or coffee grounds.
A blood stain on the sheet may sometimes be found. This is from a bug smashed after feeding.
Cause of Bed Bug Bite Reactions
The skin bumps are the body's reaction to the bug's saliva.
While the bug is sucking blood, some of its secretions get mixed in.
Bed bugs are small visible blood-sucking bugs. They are about ¼ inch (6 mm) in length.
During the day, bed bugs hide in the corners of mattresses. They may also be found in bed crevices, floors, and walls.
At night, the bed bugs come out of hiding. They feed on humans for about 5 minutes.
Prevention of Getting Bed Bugs
Over half of bed bug infestations within homes start after recent travel.
Avoid hotels and hostels where bed bugs have been reported.
When you check into a hotel room, look for signs of bed bugs. Look for flecks of their waste (like coffee grounds) in the bedding and mattress. If present, ask for another room.
Keep your luggage and clothing on a luggage rack off the floor.
When you return from a trip, place all travel clothing into the clothes dryer. Run the dryer for 20 minutes. (Reason: The heat will kill any bed bugs or their eggs that are present). One pregnant bed bug can spread bed bugs to an entire house.
Frequent Questions (FAQs)
Can bed bugs transmit HIV or hepatitis? This is highly unlikely. It has never been reported.
Do bed bugs like dirt? Not really. What bed bugs like is the warmth of the human body. Dirty and cluttered spaces just give bed bugs a place to hide.
Are bed bugs too small to be seen? No. You can see adult bed bugs. They are about the size of an apple seed (4-7 mm; ¼ inch).
Are bed bugs scared of the light? They do prefer darkness. But keeping the light on will not stop bed bugs from biting you.
When To Call
Call 911 Now
Life-threatening allergic reaction suspected. Symptoms include sudden onset of trouble breathing or swallowing.
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Spreading red area or streak with fever
Spreading red area or streak that's very large
Your child looks or acts very sick
Call Doctor Within 24 Hours
Painful spreading redness started more than 24 hours after the bite. Note: any redness starting in the first 24 hours is a reaction to the bite.
More than 48 hours since the bite and redness gets larger
You think your child needs to be seen
Call Doctor During Office Hours
Severe itching not better after 24 hours of using steroid cream
Scab that looks infected (drains pus or gets bigger) not better with antibiotic ointment
After 7 days, bites not better
After 14 days, bites not gone
You have other questions or concerns
Self Care at Home
Normal bed bug bite
Care Advice
What You Should Know About Bed Bug Bites:
Bed bug bites cause itchy red bumps.
They are usually less than ½ inch (12 mm) in size.
Some are larger (like a hive). These are normal reactions to a bed bug.
A large hive does not mean your child has an allergy.
The redness does not mean the bite is infected.
Bed bugs do not carry any infectious diseases.
Don't panic: You can get rid of bed bugs from your home.
Here is some care advice that should help.
Steroid Cream for Itching:
To reduce the itching, use 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
Apply 3 times a day until the itch is gone.
If you don't have, apply a baking soda paste until you can get some.
Allergy Medicine For Itching:
If the bite is still itchy, try an allergy medicine by mouth.
Benadryl is a good one. No prescription is needed.
Try Not to Scratch:
Cut the fingernails short.
Help your child not to scratch.
Reason: Prevent a skin infection at the bite site.
Bed Bug Repellents - Not Helpful:
Insect repellents do not keep bed bugs from biting.
Repellents containing DEET (used on skin) and permethrin (used on clothing) do not help.
Removing Bed Bugs from Your Home:
Getting rid of bed bugs requires a licensed pest control service.
Look in the phone book or on the internet under Pest Control.
What to Expect:
Any pinkness or redness usually lasts 3 days.
The swelling may last 7 days.
The itch may last for 2 weeks.
Call Your Doctor If:
Bite looks infected (redness gets larger after 48 hours)
Large red bumps last more than 7 days
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
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Definition
Sting from a bee, hornet, wasp, or yellow jacket
Over 95 percent of stings are from honey bees or yellow jackets
The main symptoms are pain and redness
Cause of Bee Sting Reactions
The bee's stinger injects venom into the skin.
The venom is what causes the symptoms.
Local Skin Reactions to the Sting
The main symptoms are pain, itching, swelling and redness at the sting site.
Pain. Severe pain or burning at the site lasts 1 to 2 hours. Itching often follows the pain.
Swelling. The bee sting may swell for 48 hours after the sting. The swelling can be small or large. Stings on the face can cause a lot of swelling around the eye. It looks bad, but this is not serious. The swelling may last for 7 days.
Redness. Bee stings are often red. That doesn't mean they are infected. Infections rarely happen with stings. The redness can last 3 days.
Anaphylactic Reaction to the Sting
A severe life-threatening allergic reaction is called anaphylaxis.
The main symptoms are hives with trouble breathing and swallowing. It starts within 2 hours of the sting.
This severe reaction to bee stings happens in 4 out of a 1,000 children.
Hives. After a bee sting, some children just develop hives all over or face swelling. Hives or face swelling alone may be able to be treated at home. But, at times, these symptoms can also lead to anaphylaxis. Be sure to call your doctor now to help decide.
Prevention of Bee Stings
Don't go barefoot if bees are around.
Be careful in gardens and orchards.
Insect repellents do not work against these stinging insects.
When To Call
Call 911 Now
Past severe allergic reaction to bee stings (not just hives) and stung less than 2 hours ago
Wheezing or trouble breathing
Hoarseness, cough or tightness in the throat or chest
Trouble swallowing or drooling
Speech is slurred
Acts or talks confused
Passed out (fainted) or too weak to stand
You think your child has a life-threatening emergency
Go to ER Now
Hives or swelling all over the body
Call Doctor or Seek Care Now
Sting inside the mouth
Sting on the eye
Stomach pain or vomiting
More than 5 stings for 10 pounds (5 kg) of weight. In teens, more than 50 stings.
Fever and sting looks infected (spreading redness)
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
More than 48 hours since the sting and redness getting larger. Note: Infection is not common. It does not start until at least 24-48 hours after the sting. Redness that starts in the first 24 hours is due to venom.
Swelling is huge (4 inches or 10 cm). It spreads across a joint such as the wrist.
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Normal reaction to bee, wasp, or yellow jacket sting
Care Advice
What You Should Know About Bee Stings:
Bee stings are common.
The main symptoms are pain and redness.
The swelling can be large. This does not mean it's an allergy.
Here is some care advice that should help.
Try to Remove the Stinger (if present):
Only honey bees leave a stinger.
The stinger looks like a tiny black dot in the sting.
Use a fingernail or credit card edge to scrape it off.
If the stinger is below the skin surface, leave it alone. It will come out with normal skin shedding.
Meat Tenderizer for Pain Relief:
Make a meat tenderizer paste with a little water. Use a cotton ball to rub it on the sting. Do this once for 20 minutes. Reason: This may neutralize the venom and reduce the pain and swelling. Caution: Do not use near the eye.
If you don't have any, use an aluminum-based deodorant. You can also put a baking soda paste on the sting. Do this for 20 minutes.
Cold Pack for Pain:
If pain does not improve after using the meat tenderizer paste, rub with an ice cube.
Do this for 20 minutes.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Steroid Cream for Itching:
For itching or swelling, put 1% hydrocortisone cream (such as Cortaid) on the sting.
No prescription is needed.
Use 3 times per day.
Allergy Medicine for Itching:
For hives or severe itching, give a dose of Benadryl.
What to Expect:
Severe pain or burning at the site lasts 1 to 2 hours.
Normal swelling from venom can increase for 48 hours after the sting.
The redness can last 3 days.
The swelling can last 7 days.
Call Your Doctor If:
Trouble breathing or swallowing occurs (mainly during the 2 hours after the sting). Call 911.
Redness gets larger after 2 days
Swelling becomes huge
Sting starts to look infected
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Raised pocket of fluid (usually clear) covered by skin
Friction Blister: Friction blisters usually occur on the palms, fingers, heels or toes.
Blood Blister: Raised pocket of bloody fluid, covered by skin. Dark red or purple in color. A blood blister can occur when the skin gets pinched (in a hinge or a closing door).
Blisters when the cause is unknown are also covered.
Causes of Blisters
Friction Blisters. Friction is the most common cause of blisters.
Burns - Chemical (Second-degree)
Burns - Thermal (Second-degree)
Frostbite (Second-degree)
Hand-Foot-and-Mouth Disease. Viral rash from Coxsackie virus gives tiny blisters on palms and soles.
Impetigo. Staph bacteria can cause impetigo with blisters.
Insect Bites. In young children, insect bites (such as fleas) can cause small blisters.
Poison Ivy, Poison Oak, Poison Sumac
Sunburn (Second-degree)
Staph Scalded Skin Syndrome (Serious). SSSS is caused by the Staph bacteria. The main finding is widespread large blisters.
Friction Blisters - Hands and Feet
Friction causes most blisters on the hands and feet.
A friction blister is a raised pocket of clear fluid covered by skin.
Cause. A friction blister is the result of forces on the skin. Shear forces separate the top layer of the skin from the lower layer. This forms a cushion (blister) of fluid over the spot of friction or pressure.
Common Sites. Fingers, palm, back of heel, top of toes, side of foot.
Hand Friction Blisters. Hand blisters are often due to friction from using a tool too much. Examples are a shovel, pick, or rake. They can also be caused by sports equipment. Examples are a tennis racquet or boat oars. Gymnastics equipment (such as high bars) may also cause hand blisters.
Foot Friction Blisters. Foot blisters are likely due to friction from an activity. Examples are hiking or running. Usually, a child has new shoes or poorly-fitting shoes. Children starting a new sport may develop blisters. Also, a risk factor to forming blisters is recently increasing the activity time.
Prevention. There are two general approaches to prevent friction blisters. These are toughening the skin and lowering the friction force.
Complications. Pain or infection.
Treatment. Painless or mildly painful small blisters can be treated at home. Use moleskin or tape that has a hole cut in the center. Larger or very painful blisters sometimes need to be drained. This can be done by making a small hole in the blister. Use a clean needle or pin. Let all the blister fluid drain out. Then the blister can be covered with antibiotic ointment and a dressing.
When To Call
Call Doctor or Seek Care Now
Fever and looks infected (spreading redness)
Widespread blisters
Cause not clear and blisters on face
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Looks infected (spreading redness or pus)
Severe pain and you want your doctor to drain the blister
Cause not clear and blister on one or more finger pads
Cause not clear and new blisters are developing
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
No new blisters but cause not clear
You have other questions or concerns
Self Care at Home
Normal blister from friction
Normal blood blister from pinch injury to skin
Questions about prevention of foot blisters from hiking or running
Questions about prevention of hand blisters from sports or tools
Care Advice
Treatment of Normal Friction Blister
What You Should Know - Friction Blister:
A friction blister is a raised pocket of clear fluid, covered by skin.
Most blisters should not be opened. Reason: It increases the risk of infection.
However, large or severely painful blisters often need to be drained. This is done by poking a small hole in the blister with a needle. (See #4 below)
Here is some care advice that should help.
Protect the Blister:
Goal: Protect the blister from any more rubbing.
Surround it with a "donut" made from moleskin. Ask for this product at your drug store.
Using scissors, cut a moleskin piece to a shape larger than the blister.
Next cut a hole the size of the blister in the center. Do this by folding the moleskin in half and cut along the fold.
Remove the covering from the sticky side. Then, put the moleskin on with the blister in the center.
If the blister is taller than the moleskin, add one more layer of moleskin.
Hold the "donut" in place with a large strip of duct tape.
Other option. If you don't have moleskin, use a bandage (such as Band-Aid). Fold it and cut the center out to the size of the blister.
For foot blisters, also switch to shoes that don't rub the blister.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Severe Pain - Drain the Blister:
Draining a large blister can help make the pain go away.
Wash the skin with warm water and soap.
Clean a needle or straight pin with rubbing alcohol.
Gently press the fluid to one side of the blister to create a bulge.
Pass the needle sideways through the fluid making 2 puncture holes. Gently wiggle the needle to make the holes larger.
Remove the needle.
Press the fluid out through the holes.
Leave the roof of the blister in place to protect the raw skin underneath.
Use an antibiotic ointment (such as Polysporin). No prescription is needed. Put it on twice per day after cleansing.
Cover the drained blister with a bandage (such as Band-Aid).
Broken Blister Treatment:
If the blister breaks open, let it drain.
Leave the roof of the blister in place to protect the raw skin underneath.
If there are any loose flaps of skin, trim them with a fine scissors.
Wash it with warm water and soap.
Use an antibiotic ointment (such as Polysporin). No prescription is needed. Put it on twice a day.
Cover it with a bandage (such as Band-Aid).
What to Expect:
Most often, they dry up and peel off without any treatment.
This may take 1 to 2 weeks.
Call Your Doctor If:
Blister looks infected
Severe pain and you want your child's doctor to drain the blister
You think your child needs to be seen
Your child becomes worse
Treatment of Normal Blood Blister
What You Should Know - Blood Blister:
A blood blister can happen when the skin gets pinched. Examples are a finger caught in a hinge or a closing door.
It forms a tiny pocket of bloody fluid covered by skin. It is dark red or purple in color.
A blood blister is not harmful.
No treatment is needed. You do not need to drain it.
It will slowly dry up and peel off over 1-2 weeks.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Call Your Doctor If:
You think your child needs to be seen
Your child becomes worse
Prevention of Foot Blisters
Prevention - General:
Shoes. Buy shoes that fit. Do not wear shoes that are too tight or too loose. New hiking boots are often somewhat stiff. It is wise to first wear them around the house and on short walks. Wear them in before wearing them on a long hike.
Socks. Do not use cotton socks. They tend to stay damp when wearing. Instead use synthetic (acrylic) or wool socks. Some people prefer to wear two socks at a time. You can wear a thin inner liner ('wicking') sock and a thicker outer sock.
Lubricants. If your child often gets blisters at the same spot, use a lubricant. You can use petroleum jelly (such as Vaseline). Cover the area with a small amount of the lubricant before sports. This will help to reduce friction on the spot.
Callus. If blisters usually occur under a callus, file the callus down. Then, lubricate it. This way it won't add to the friction.
Taping Pressure Points. If a lubricant doesn't stop blisters, taping is the next step. Taping is a very good way to treat hot spots for friction blisters. Many hikers and runners use taping. Follow the instructions listed down below.
Prevention - Taping:
Option 1 - Moleskin
You can get moleskin at your drug store. It is a good way to stop friction blisters. Here are some instructions on how to use moleskin.
Using scissors, cut the moleskin to a shape slightly larger than the pressure point.
Remove the backing from the moleskin. Put it on the pressure point. Smooth it from the center outward so that there are no wrinkles.
Put on a clean and dry sock.
Option 2 - Taping with Duct Tape
Duct tape is available at your hardware store. It is also good at stopping friction blisters. Many hikers and runners use it. Here are some instructions on how to use duct tape.
Using scissors, cut out a piece of duct tape into a shape slightly larger than the pressure point.
Apply the piece of duct tape to the pressure point. Smooth it from the center outward so that there are no wrinkles.
Put on a clean and dry sock.
Prevention - Toughening the Skin:
This mainly applies to walkers, hikers, and runners.
Slowly add to the distance you hike or run over days to weeks. This will increase the toughness of the skin. It will lower the risk of blisters forming.
Call Your Doctor If:
You have other questions or concerns
Prevention of Hand Blisters
Prevention:
Gloves. Wear heavy-duty work gloves when working with the hands. Also, use gloves when working with tools. Examples are shovels, picks, and rakes. Sports gloves can be used for rowing, paddling, weight lifting or cycling.
Lubricants. Lower friction at pressure points by covering them with a lubricant. You can use petroleum jelly (such as Vaseline).
Call Your Doctor If:
You have other questions or concerns
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Painful red lump in the skin
Hair follicle infection caused by the Staph bacteria
Most boils need to be seen by a doctor
Symptoms of a Boil
Bright red lump (swelling) in the skin.
Painful, even when not being touched.
Most often ½ to 1 inch across (1 to 2 cm).
After about a week, the center of the boil becomes filled with pus. The center becomes soft and mushy.
The skin over the boil then develops a large pimple. This is known as "coming to a head."
Causes of Boils
A boil is an infection of a hair follicle (skin pore).
Boils are caused by the Staph bacteria.
Friction from tight clothing is a risk factor. Common sites are the groin, armpit, buttock, thigh or waist.
Shaving is also a risk factor. Common sites are the face, legs, armpits or pubic area.
Prevention of Boils
Washing hands is key to preventing Staph skin infections. Have everyone in the home wash their hands often. Use a liquid antibacterial soap or alcohol hand sanitizer. Have everyone shower daily. Showers are best, because baths still leave many Staph bacteria on the skin.
Avoid nose picking. 30% of people have Staph bacteria in their nose.
When shaving anywhere on the body, never try to shave too close. Reason: It causes small cuts that allow Staph bacteria to enter the skin.
Prevention - Bleach Baths for Boils that Come Back.
Some doctors suggest bleach baths to prevent boils from coming back. Talk with your doctor about this treatment.
Use ½ cup (120 mL) of regular bleach per 1 full bathtub of water.
Soak for 10 minutes twice weekly.
This mix of bleach and water is like a swimming pool.
When To Call
Call Doctor or Seek Care Now
Widespread red rash
Fever
Boil on the face
Age less than 1 month old (newborn) with a boil
Weak immune system. Examples are sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Age less than 1 year old with a boil
Spreading redness around the boil
There are 2 or more boils
Size is larger than 2 inches (5 cm) across
Center of the boil is soft or pus-colored. Exception: a common pimple.
Boil is draining pus
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Boil suspected (red lump larger than ½ inch or 12 mm across). Reason: confirm your child does have a boil. Note: see home care advice for boil treatment.
Using antibiotic ointment more than 3 days for small red lump, but not improved
Boils keep coming back in your family
You have other questions or concerns
Self Care at Home
Boil diagnosed by a doctor
Possible boil not yet seen by a doctor: painful red lump larger than ½ inch (12 mm) across
Possible early boil or minor skin infection: tender red lump smaller than ½ inch (12 mm) across. Note: see home care advice for small red lump.
Care Advice
Treatment for a Boil (painful red lump larger than ½ inch or 12 mm across)
What You Should Know About Boils:
A boil is a Staph infection of a hair follicle.
It is not a serious infection.
Boils should be seen by a doctor for treatment.
The doctor can tell if it needs to be drained and when to do it.
Here is some care advice that should help.
Moist Heat:
Heat can help bring the boil "to a head," so it can be drained.
Apply a warm, wet washcloth to the boil. Do this for 15 minutes 3 times a day.
Pain Medicine:
Until it drains, all boils are painful.
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Opening the Boil - Done Only by a Doctor:
The main treatment of boils is to open them and drain the pus.
Then, boils will usually heal on their own.
Draining the boil must always be done in a medical setting.
Caution - Do Not Squeeze:
Do not squeeze a boil or try to open a boil yourself.
Reason: this can force bacteria into the bloodstream or cause more boils.
Squeezing a boil on the face can be very harmful.
Antibiotics By Mouth:
Antibiotics may or may not be helpful. Your doctor will decide.
If prescribed, take the antibiotic as directed.
Pus Precautions:
Pus or other drainage from an open boil contains lots of Staph bacteria.
Once a boil is opened it will drain pus for 3 to 4 days. Then it will slowly heal up.
Cover all draining boils with a clean, dry bandage. A gauze pad and tape work well.
Change the bandage twice daily.
Clean the skin around the boil with an antibacterial soap each time.
Carefully throw the bandage away in the regular trash.
Wash your hands well after any contact with the boil, drainage or the bandage.
What to Expect:
Without treatment, the body will slowly wall off the Staph infection.
After about a week, the center of the boil will fill with pus. It will become soft.
The skin over the boil then develops a large pimple. This is known as "coming to a head."
The boil is now ready for draining by your doctor.
Without draining, it will open and drain by itself in 3 or 4 days.
Return to School or Child Care:
Closed boils cannot spread to others.
Children with a closed boil can go to school or child care.
The pus or drainage in open boils can spread infection to others.
For open boils, the drainage needs to be fully covered with a dry bandage. If not, stay home until it heals up (most often 1 week).
Return to Sports:
Children with a closed boil may be able to play sports.
Children with an open boil cannot return to contact sports until drainage has stopped.
Check with the team's trainer, if there is one.
Call Your Doctor If:
Fever occurs
Redness spreads beyond the boil
Boil becomes larger than 2 inches (5 ml) across
Boil comes to a head (soft pus-colored center)
You think your child needs to be seen
Your child becomes worse
Treatment for a Small Tender Red Lump (less than ½ inch or 12 mm across)
What You Should Know About a Small Tender Red Lump:
A small red lump most often is a minor infection of a hair follicle.
It may or may not become a boil.
Use an antibiotic ointment to keep it from getting worse. No prescription is needed.
Apply it to the red lump 3 times per day.
Pain Medicine:
If painful, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Caution - Do Not Squeeze:
Do not squeeze skin lump. Reason: squeezing it can force bacteria into the skin.
Call Your Doctor If:
Red lump becomes larger or bigger than ½ inch (12 mm)
Not improved after using antibiotic ointment for 3 days
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Injuries to the skin anywhere on the body surface
Includes cuts, scratches, scrapes, bruises and swelling
Types of Skin Injury
Cuts, lacerations, gashes and tears. These are wounds that go through the skin to the fat tissue. Caused by a sharp object.
Scrapes, abrasions, scratches and floor burns. These are surface wounds that don't go all the way through the skin. Scrapes are common on the knees, elbows and palms.
Bruises. These are bleeding into the skin from damaged blood vessels. Caused by a blunt object. They can occur without a cut or scrape.
When Sutures (Stitches) are Needed for Cuts
Any cut that is split open or gaping needs sutures.
Cuts longer than ½ inch (12 mm) usually need sutures.
On the face, cuts longer than ¼ inch (6 mm) usually need to be seen. They usually need closure with sutures or skin glue.
Any open wound that may need sutures should be seen as soon as possible. Ideally, they should be checked and closed within 6 hours. Reason: to prevent wound infections. There is no cutoff, however, for treating open wounds.
Cuts Versus Scratches: Helping You Decide
The skin is about 1/8 inch (3 mm) thick.
A cut (laceration) goes through it.
A scratch or scrape (wide scratch) doesn't go through the skin.
Cuts that gape open at rest or with movement need stitches to prevent scarring.
Scrapes and scratches never need stitches, no matter how long they are.
So this distinction is important.
When To Call
Call 911 Now
Major bleeding that can't be stopped
Deep cut to chest, stomach, head or neck (such as with a knife)
Go to ER Now
Bleeding that won't stop after 10 minutes of direct pressure
Cut or scrape is very deep (can see bone or tendons)
Large deep cut that will need many stitches
Call Doctor or Seek Care Now
Skin is split open or gaping and may need stitches
Severe pain and not better 2 hours after taking pain medicine
Age less than 1 year old
Dirt in the wound is not gone after 15 minutes of scrubbing
Skin loss from bad scrape goes very deep
Bad scrape covers large area
Cut or scrape looks infected (redness, red streak or pus)
Cut or scrape and no past tetanus shots
You think your child has a serious injury
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Very large bruise after a minor injury
Some bruises appear without any known injury
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Dirty cut and no tetanus shot in more than 5 years
Clean cut and no tetanus shot in more than 10 years
Doesn't heal by 10 days
You have other questions or concerns
Self Care at Home
Minor cut, scrape or bruise (minor bleeding that stops)
Care Advice
Cuts, Scratches and Scrapes - Treatment:
Use direct pressure to stop any bleeding. Do this for 10 minutes or until the bleeding stops.
Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water.
Caution: Never soak a wound that might need sutures. Reason: It may become more swollen and harder to close.
Gently scrub out any dirt with a washcloth.
Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover it with a bandage (such as Band-Aid). Change daily.
Liquid Skin Bandage for Minor Cuts and Scrapes:
Liquid skin bandage seals wounds with a plastic coating. It lasts up to 1 week.
Liquid skin bandage has several benefits compared to other bandages (such as Band-Aid). Liquid bandage only needs to be put on once. It seals the wound and may promote faster healing and lower infection rates. Also, it's water-proof.
Wash and dry the wound first. Then, put on the liquid. It comes with a brush or swab. It dries in less than a minute.
You can get this product at a drugstore near you. There are many brands of liquid bandage. No prescription is needed.
Bruises - Treatment:
Use a cold pack or ice bag wrapped in a wet cloth. Put it on the bruise once for 20 minutes. This will help to stop the bleeding.
After 48 hours, use a warm wet wash cloth. Do this for 10 minutes 3 times per day. This helps to reabsorb the blood.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Tetanus Shot:
A tetanus shot update may be needed for cuts and other open wounds.
Check your vaccine records to see when your child got the last one.
For Dirty Cuts and Scrapes. If last tetanus shot was given over 5 years ago, need a booster.
For Clean Cuts. If last tetanus shot was given over 10 years ago, need a booster.
See your child's doctor for a booster during regular office hours. It's safe to give it within 3 days or less.
What to Expect:
Small cuts and scrapes heal up in less than a week.
Call Your Doctor If:
Bleeding does not stop after using direct pressure to the cut
Starts to look infected (pus, redness)
Doesn't heal by 10 days
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Burns to the skin
A burn is a heat, chemical or electrical injury to the skin
Causes of Burns
Hot Liquids. Hot liquids (such as coffee) are the most common cause of burns. They cause a scald.
Hot Surfaces. Examples are ovens, stoves, space heaters and curling irons.
Chemical Burns (Serious). Examples are acids or lye splashed on the skin. They continue to damage the skin until they are removed.
Electrical Burns (Serious). They can be much deeper than they first appear.
Flame Burns (Serious). Flammable liquid burns are mainly seen in teen boys.
Friction Burns. Treadmill burns are a common example.
Sunburn is not covered here. See the Sunburn care guide.
Degrees of Burns
1st degree. Red skin without blisters. These burns don't need to be seen.
2nd degree. Red skin with blisters. Heals from the bottom up, not from the edges. Takes 2 to 3 weeks. Small closed blisters decrease pain and act as a natural bandage.
3rd degree. Deep burns with white or charred skin. There are no blisters. Skin feeling is lost. Heals in from the edges. Grafts are often needed if it is larger than a quarter in size. These are burns over 1 inch or 2.5 cm. Skin grafts help limit scarring.
When To Call
Call 911 Now
2nd or 3rd degree burn covers a large area
Trouble breathing with burn to the face
Trouble breathing after being near fire, smoke or fumes
Hard to wake up
Acts or talks confused
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Eye or eyelid burn
Burn goes all the way around an arm or leg
Center of the burn is white or charred
Electrical burn
Explosion or gun powder caused the burn
Chemical burn (such as acid)
Coughing after being near fire and smoke
House fire burn
Severe pain and not better 2 hours after taking pain medicine
Burn looks infected (spreading redness, red streaks, swelling, or tender to the touch)
You think your child has a serious burn
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Blister is present. Exception: small closed blister less than ½ inch or 12 mm size.
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Minor burn and last tetanus shot more than 10 years ago
Burn not healed after 10 days
You have other questions or concerns
Self Care at Home
Minor heat or chemical burn
Blisters less than ½ inch (12 mm) size
Care Advice
What You Should Know About Burns :
Minor burns can be treated at home.
This includes some small blisters.
Here is some care advice that should help.
Cold Pack for Pain:
For pain, put a cold wet washcloth on the burn.
Repeat as needed.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Clean the Burn:
Wash the burn gently with warm water.
Do not use soap unless the burn is dirty. Reason: Soaps can slow healing.
Closed Blisters - Don't Open:
Don't open any small closed blisters.
The outer skin protects the burn from infection.
Antibiotic Ointment for Open Blisters:
For any broken blisters, use an antibiotic ointment (such as Polysporin). No prescription is needed.
Then cover it with a bandage (such as Band-Aid). Change the dressing every other day.
Each time, clean the area. Use warm water and 1 or 2 gentle wipes with a wet washcloth.
What to Expect:
Most often, burns hurt for about 2 days.
It will peel like a sunburn in about a week.
First- and second-degree burns don't leave scars.
Call Your Doctor If:
Severe pain lasts over 2 hours after taking pain medicine
Burn starts to look infected (spreading redness, pus)
Burn not healed after 10 days
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A rash all over the body caused by the chickenpox virus.
The chickenpox rash starts as small red bumps. The bumps change to blisters or pimples. The bumps change to open sores, and finally they scab over.
A doctor has told you that your child has chickenpox.
Or your child had close contact with another person who has it (or shingles). The contact should be 10-21 days earlier.
Symptoms of Chickenpox
Chickenpox starts with some small water blisters or pimples on the head and trunk.
Chickenpox progress within 24 hours through the next 5 stages:
Small red bumps
Thin-walled water blisters
Cloudy blisters
Open sores, and finally
Dry brown crusts.
Rash is all over the body. Most often, starts on the head and back.
Repeated crops of new chickenpox keep appearing for 4 to 5 days. Therefore, all 5 stages are present at same time.
Sores (ulcers) can also occur in the mouth, on eyelids, and on genitals.
Fever is most often present. The more the rash, the higher the fever.
Known contact to a child with chickenpox or shingles 10 - 21 days earlier
Main related problems: skin infections from scratching.
Cause of Chickenpox
Chickenpox is caused by a virus. It is called Varicella.
Chickenpox can be prevented by getting this vaccine against this virus.
When To Call
Call 911 Now
Not moving or too weak to stand
You think your child has a life-threatening emergency
Go to ER Now
Stiff neck (can't touch chin to the chest)
Hard to wake up or confused when awake
Call Doctor or Seek Care Now
Bright red skin or red streak
Very painful swelling or very swollen face
New red rash in addition to chickenpox rash
Walking is not steady
Trouble breathing
Bleeding into the chickenpox
Fever over 104° F (40° C)
Age less than 1 month old
Vomits 3 or more times
Eye pain or constant blinking
Took a steroid medicine within past 2 weeks
Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
Chronic skin disease (such as eczema)
Chronic lung disease (such as cystic fibrosis)
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Age less than 1 year old
Teen 13 years or older has chickenpox
Been near to person with chickenpox or shingles in last 5 days. Also, healthy person who never had a chickenpox vaccine.
One lymph node gets larger and more tender
Fever lasts more than 4 days
Fever returns after being gone more than 24 hours
Scab or sore drains yellow pus
One sore gets much larger in size than the others
Gets new chickenpox after day 6
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Chickenpox with no other problems
Care Advice
What You Should Know About Chickenpox:
Chickenpox is caused by the varicella virus.
It's now uncommon because of the chickenpox vaccine.
Your job is to keep your child comfortable and to limit the itching.
Here is some care advice that should help.
Cool Baths for Itching:
For itching, give cool or lukewarm baths for 10 minutes as often as needed.
Caution: Avoid any chill.
Can add baking soda 2 ounces (60 mL) per tub.
Baths don't spread the chickenpox.
Do not use soaps. Reason: Soaps cause dry skin and make the itch worse.
Calamine Lotion for Itching:
Put calamine lotion on the chickenpox that itch the most.
You can also use an ice cube on the itchy spots for 10 minutes.
Don't use any lotion containing Benadryl in it. Reason: It can be absorbed across the skin. This can cause side effects in kids.
Allergy Medicine for Itching:
If itching becomes severe or interferes with sleep, give Benadryl by mouth.
Try Not to Scratch:
Try not to let your child pick and scratch at the sores. This can lead to infected sores.
Trim fingernails.
Wash hands often with soap.
Fever Medicine:
Give acetaminophen (such as Tylenol) for fever above 102° F (39° C).
Never use aspirin. Reason: Risk of Reye syndrome.
Also, don't use ibuprofen products (such as Advil). Reason: May increase risk of bad strep skin infections.
Fluids and Soft Diet:
The mouth and throat ulcers are painful. Try to get your child to drink adequate fluids.
Goal: Keep your child well hydrated.
Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
Solids. Offer a soft diet. Also, avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
Liquid Antacid for Mouth Pain (Age 1 Year and Older):
For mouth pain, use a liquid antacid (such as Mylanta or the store brand). Give 4 times per day as needed. After meals often is a good time.
Age 1 to 6 years. Put a few drops in the mouth. Can also put it on with a cotton swab.
Age over 6 years. Use 1 teaspoon (5 mL) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
Caution: Do not use regular mouth washes, because they sting.
Ointment For Pain With Passing Urine:
For girls with painful genital ulcers, use petroleum jelly (such as Vaseline).
Put on the sores as needed.
For males with painful pox on the tip of the penis, this also works.
Return to School:
Your child can go back to school after all the sores have crusted over.
Most often, this is day 6 or 7 of the rash.
What to Expect:
Expect new chickenpox every day for 4 or 5 days.
Most children get 400 to 500 chickenpox.
They get less pox if they've had the vaccine.
Prevent the Spread of Chickenpox in the Office:
If your child needs to be seen, call first to the office.
Try to bring another adult. Have one adult enter the office first for instructions.
For nonurgent problems, the doctor may do an exam in the car.
Call Your Doctor If:
Chickenpox look infected (draining pus, scabs become larger)
Gets any new chickenpox after day 6
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
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Definition
Cracked skin or dry, rough skin
Cracked skin on hands, feet and lips
Dry, rough skin of entire body surface
Causes of Cracks in the Skin
Most cracked skin is found on the feet, hands or lips.
Feet. The soles of the feet are most commonly involved. Most often, cracks occur on the heels and big toes. This is called tennis shoe dermatitis. Deep cracks are very painful and can bleed. The main cause is wearing wet or sweaty socks or swimming a lot.
Hands. Cracks can develop on the hands in children. The main cause is washing the hands too much or washing dishes. Can also occur from working outside in winter weather. The worse cracks of the fingers occur with thumb sucking.
Lips. The lips can become chapped in children from the sun or wind. If the lips become cracked, it's usually from a "lip-licking" habit. The skin around the lips can also become pink and dry. This occurs especially in children who suck on their lips.
Causes of Dry Skin
Dry skin is a common condition.
Soap. Dry skin is mainly caused by too much bathing and soap (soap dermatitis). Soap removes the skin's natural protective oils. Once they are gone, the skin can't hold moisture.
Climate. Dry climates make dry skin worse, as does winter weather (called winter itch).
Genetics also plays a role in dry skin.
Dry skin is less common in teenagers than younger children. This is because the oil glands are more active.
Keratosis Pilaris - dry, rough, bumpy skin on the back of the upper arms. It's made worse by soaps. Treat with moisturizing creams.
Pityriasis Alba - dry pale spots on the face. These are more prevalent in the winter time and are also made worse by soaps. Treat with moisturizing creams.
Eczema. Children with eczema have very dry itchy skin.
Liquid Skin Bandage For Deep, Chronic Cracks
Liquid plastic skin bandage is a new product that seals wounds. It is a plastic coating that lasts up to 1 week.
It is the best way to relieve pain and promote healing. As the crack heals from the bottom upward, it pushes the plastic seal up.
After the wound is washed and dried, put the liquid on. It comes with a small brush or with a swab. It dries in less than a minute. Then apply a second coat. It's waterproof and may last a week.
You can buy this at any drug store. Many brands of liquid bandage are available. No prescription is needed.
When To Call
Call Doctor or Seek Care Now
Fever and looks infected (spreading redness)
Cracked red lips and fever lasts 5 days or more
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Looks infected (pus or spreading redness)
Bleeding from cracked lips
Cracks on feet that make it hard to walk
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Cracks from thumb-sucking or finger-sucking
Peeling skin and cause is not clear
After 2 weeks of treatment, cracked lips are not healed
After 2 weeks of treatment, cracked skin is not healed
After 2 weeks of treatment, dry skin is still itchy
You have other questions or concerns
Self Care at Home
Cracked skin on the feet
Cracked skin on the hands
Chapped lips
Dry, itchy skin caused by soap or cold/dry weather
Care Advice
Treatment for Cracked Skin on the Feet
What You Should Know About Cracks on Feet:
Most often, cracked skin of the feet is caused by repeated contact with moisture.
The main cause is often wearing wet (or sweaty) socks. Swimmers also have this problem.
The soles of the feet are most often involved. Usually, you see cracks on the heels and big toes.
This is called tennis shoe or sneaker dermatitis.
Cracked, dry feet usually can be treated at home.
Here is some care advice that should help.
Shallow Cracks - Use Ointment:
Cracks heal faster if protected from air exposure and drying.
Keep the cracks constantly covered with petroleum jelly (such as Vaseline). Put it on the cracks 3 times a day.
If the crack seems mildly infected, use an antibiotic ointment instead (such as Polysporin). No prescription is needed. Put it on the cracks 3 times a day.
Covering the ointment with a bandage (such as Band-Aid) speeds recovery. You can also cover it with a sock.
Option: If you have it, a liquid skin bandage works even better. Don't use liquid bandage and ointment together.
Deep Cracks - Use Liquid Skin Bandage:
Deep cracks of the feet or toes usually do not heal with ointments.
Use a liquid skin bandage that will completely seal the crack. Many brands of liquid bandage are available. No prescription is needed.
Start with 2 layers. Put on another layer as often as needed.
As the crack heals, the plastic layer will be pushed up.
Prevention of Cracks on Feet:
Change socks whenever they are wet or sweaty.
Take an extra pair of socks to school.
When practical, do not wear shoes. Go barefoot or wear socks only.
Do not use bubble bath or other soaps in the bath water. Soaps take the natural oils out of the skin.
Use a moisturizing cream on the feet after baths or showers.
Wear shoes that allow the skin to "breathe."
What to Expect:
Most cracks heal over in 1 week with treatment.
Deep cracks heal if you keep them covered all the time with crack sealer. Deep cracks will heal in about 2 weeks with crack sealer.
Call Your Doctor If:
Starts to look infected (redness, red streak, pus)
Cracks last more than 2 weeks on treatment
You think your child needs to be seen
Your child becomes worse
Treatment for Cracked Skin on the Hands
What You Should Know About Cracks on Hands:
Cracked skin of the hands is usually caused by repeated contact with moisture.
Examples are washing dishes or washing the hands often.
Soap removes the natural protective oils from the skin.
Cracked, dry hands usually can be treated at home.
Here is some care advice that should help.
Shallow Cracks - Use Ointment:
Cracks heal faster if protected from air exposure and drying.
Keep the cracks constantly covered with petroleum jelly (such as Vaseline). Put it on the cracks 3 times a day.
If the crack seems mildly infected, use an antibiotic ointment instead (such as Polysporin). No prescription is needed. Put it on the cracks 3 times a day.
Covering the ointment with a bandage (such as Band-Aid) speeds recovery. You can also cover it with a glove.
Option: If you have it, a liquid skin bandage works even better. Don't use liquid bandage and ointment together.
Deep Cracks - Use Liquid Skin Bandage:
Deep cracks of the fingers usually do not heal with ointments.
Use a liquid skin bandage that will completely seal the crack. Many brands of liquid bandage are available. No prescription is needed.
Start with 2 layers. Put on another layer as often as needed.
As the crack heals, the plastic layer will be pushed up.
Prevention of Cracks on Hands:
Wash the hands with warm water.
Use soap only if the hands are very dirty. Also, use soap for anything that won't come off with water.
Wear gloves when washing dishes.
During cold weather, wear gloves outside.
Use a moisturizing cream on the hands after anytime they have been in water.
What to Expect:
Most cracks heal over in 1 week with treatment.
Deep cracks heal if you keep them covered all the time with crack sealer. Deep cracks will heal in about 2 weeks with crack sealer.
Call Your Doctor If:
Starts to look infected (redness, red streak, pus)
Cracks last more than 2 weeks on treatment
You think your child needs to be seen
Your child becomes worse
Treatment for Chapped Lips
What You Should Know About Chapped Lips:
The lips can become chapped in children from too much sun or wind.
If the lips become cracked, it's usually from a "lip-licking" habit.
The skin around the lips can also become pink and dry. This occurs especially when children suck on their lips.
Here is some care advice that should help.
Lip Balm:
A lip balm should be used often, even hourly.
Be sure to put it on after eating or drinking.
Avoid "Lip-Licking":
Help your child give up the habit of lip-licking or sucking.
This habit usually is not seen before age 6.
This habit will only change if you can gain your child's active participation.
Appeal to your child's pride. Show your child in a mirror how lip-sucking has affected their appearance.
Give them a lip lubricant to put on their lips. Tell them to use it when they feel the urge to suck on them. Another option is to replace lip-sucking with chewing gum.
Offer an incentive for going an entire day without lip-sucking. Examples of rewards are money or points towards a prize.
Avoid any pressure or punishment. It will backfire, cause a power struggle and make the habit last longer.
Call Your Doctor If:
Starts to look infected (redness, red streak, pus)
Cracks last more than 2 weeks on treatment
You think your child needs to be seen
Your child becomes worse
Treatment for Dry or Itchy Skin
What You Should Know About Dry Skin:
Dry skin is a common condition.
Mainly caused by too much bathing and soap (soap dermatitis).
Soap removes the skin's natural protective oils. Once they are gone, the skin can't hold moisture.
Dry climates make it worse, as does winter weather (called winter itch).
Genetics also plays a role in dry skin.
Dry skin is less common in teenagers than younger children. This is because the oil glands are more active in teens.
Here is some care advice that should help.
Bathing - Avoid Soap:
Young children with dry skin should avoid all soaps. Soaps take the natural protective oils out of the skin. Bubble bath does the most damage.
For young children, the skin can be cleansed with warm water alone. Keep bathing to 10 minutes or less.
Most young children only need to bathe twice a week.
Teenagers can get by with using soap only for the armpits, genitals, and feet. Also, use a mild soap (such as Dove).
Do not use any soap on itchy areas or rashes.
Moisturizing Cream:
Buy a large bottle of moisturizing cream (such as Eucerin). Avoid those with fragrances.
Put the cream on any dry or itchy area 3 times per day.
After warm water baths or showers, trap the moisture in the skin. Do this by putting on the cream everywhere after bathing. Use the cream within 3 minutes of completing the bath.
During the winter, apply the cream every day to prevent dry skin.
Steroid Cream:
For very itchy spots, use 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
Use up to 3 times per day as needed until the itching is better.
Eventually, the moisturizing cream will be all that you need for treating dry skin.
Humidifier:
If your winters are dry, protect your child's skin from the constant drying effect.
Do this by running a room humidifier full time.
Preventing Dry Skin:
Don't use soaps or bubble bath.
Wash the hands with warm water. Use soap only if the hands are very dirty. Also, use soap for anything that won't come off with water.
Don't use swimming pools or hot tubs. Reason: Pool chemicals are very drying.
Run a humidifier in the winter if the air is dry.
During cold weather, wear gloves outside. This helps prevent drying of the skin.
Drink lots of fluids.
Call Your Doctor If:
Dry skin lasts more than 2 weeks on treatment
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A scaly rash on the scalp that starts in newborns
Symptoms of Cradle Cap
Yellow scales and crusts attached to the scalp
Occurs in patches
Scales can be greasy or dry
Not itchy or painful
Begins in the first 2 to 6 weeks of life
Cause of Cradle Cap
Cradle cap is probably caused by hormones from the mother. These hormones cross the placenta before birth. The hormones cause the oil glands in the skin to become overactive. They then release more oil than normal.
Dead skin cells normally fall off. The extra oil causes these cells to "stick" to the skin. These cells form yellow crusts and scales on the scalp.
When To Call
Call Doctor or Seek Care Now
Baby under 1 month old with tiny water blisters or pimples in a cluster
Your child looks or acts very sick
Call Doctor Within 24 Hours
Baby under 1 month old with any water blisters or pimples
You think your child needs to be seen
Call Doctor During Office Hours
Raw rash behind the ears
Rash spreads beyond the scalp
Cradle cap gets worse with treatment
Cradle cap lasts longer than 12 months
You have other questions or concerns
Self Care at Home
Mild cradle cap
Care Advice
What You Should Know About Cradle Cap:
Cradle cap is a common skin condition of newborns.
It's caused by overactive oil glands in the scalp.
It's harmless and will go away on its own. But it takes time.
Here is some care advice that should help.
Shampoo Daily:
Wash the hair with an anti-dandruff shampoo (such as Head and Shoulders). Do this twice a week. No prescription is needed. Note: The daily use of anti-dandruff shampoo isn't approved until after 2 years old. But, using it twice a week is fine.
On the other days, wash the hair with baby shampoo.
Scalp Massage:
While the hair is lathered, massage the scalp with a soft brush. You can also use a rough washcloth or your fingers for 5 minutes. Don't worry about hurting the soft spot.
Baby Oil:
If the scalp has thick crusts (scales), put some baby oil on the scalp. Do this for 15 minutes before shampooing to soften the crusts.
Wash all the oil off, however, or it may worsen the cradle cap. (Reason: The oil blocks the oil glands on the baby's scalp.)
Do not use olive oil. (Reason: may increase the growth of yeast)
Cradle cap lotions for loosening up the scales are also available without a prescription. Apply the lotion 15 minutes before shampooing.
Steroid Cream:
If the rash on the scalp is red and irritated, use 1% hydrocortisone cream. An example is Cortaid. No prescription is needed.
Put this on once a day.
After 1 hour, wash it off with soap and water.
Do this for 7 days or less.
Expected Course:
Cradle cap will eventually go away on its own between 6 and 12 months of age. Usually, it doesn't cause any symptoms (such as pain or itching).
Therefore, treatment is optional. It is mainly done for cosmetic reasons.
Shampoos, lotions and brushing will reduce the thickness of the scales. They will usually make them go away sooner.
Return to Child Care:
Cradle cap cannot be spread to others.
Your child does not need to miss any child care.
Call Your Doctor If:
Gets worse with treatment
Lasts over 12 months of age
You think your child needs to be seen
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Injuries to the skin anywhere on the body surface
Includes cuts, scratches, scrapes, bruises and swelling
Types of Skin Injury
Cuts, lacerations, gashes and tears. These are wounds that go through the skin to the fat tissue. Caused by a sharp object.
Scrapes, abrasions, scratches and floor burns. These are surface wounds that don't go all the way through the skin. Scrapes are common on the knees, elbows and palms.
Bruises. These are bleeding into the skin from damaged blood vessels. Caused by a blunt object. They can occur without a cut or scrape.
When Sutures (Stitches) are Needed for Cuts
Any cut that is split open or gaping needs sutures.
Cuts longer than ½ inch (12 mm) usually need sutures.
On the face, cuts longer than ¼ inch (6 mm) usually need to be seen. They usually need closure with sutures or skin glue.
Any open wound that may need sutures should be seen as soon as possible. Ideally, they should be checked and closed within 6 hours. Reason: to prevent wound infections. There is no cutoff, however, for treating open wounds.
Cuts Versus Scratches: Helping You Decide
The skin is about 1/8 inch (3 mm) thick.
A cut (laceration) goes through it.
A scratch or scrape (wide scratch) doesn't go through the skin.
Cuts that gape open at rest or with movement need stitches to prevent scarring.
Scrapes and scratches never need stitches, no matter how long they are.
So this distinction is important.
When To Call
Call 911 Now
Major bleeding that can't be stopped
Deep cut to chest, stomach, head or neck (such as with a knife)
Go to ER Now
Bleeding that won't stop after 10 minutes of direct pressure
Cut or scrape is very deep (can see bone or tendons)
Large deep cut that will need many stitches
Call Doctor or Seek Care Now
Skin is split open or gaping and may need stitches
Severe pain and not better 2 hours after taking pain medicine
Age less than 1 year old
Dirt in the wound is not gone after 15 minutes of scrubbing
Skin loss from bad scrape goes very deep
Bad scrape covers large area
Cut or scrape looks infected (redness, red streak or pus)
Cut or scrape and no past tetanus shots
You think your child has a serious injury
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Very large bruise after a minor injury
Some bruises appear without any known injury
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Dirty cut and no tetanus shot in more than 5 years
Clean cut and no tetanus shot in more than 10 years
Doesn't heal by 10 days
You have other questions or concerns
Self Care at Home
Minor cut, scrape or bruise (minor bleeding that stops)
Care Advice
Cuts, Scratches and Scrapes - Treatment:
Use direct pressure to stop any bleeding. Do this for 10 minutes or until the bleeding stops.
Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water.
Caution: Never soak a wound that might need sutures. Reason: It may become more swollen and harder to close.
Gently scrub out any dirt with a washcloth.
Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover it with a bandage (such as Band-Aid). Change daily.
Liquid Skin Bandage for Minor Cuts and Scrapes:
Liquid skin bandage seals wounds with a plastic coating. It lasts up to 1 week.
Liquid skin bandage has several benefits compared to other bandages (such as Band-Aid). Liquid bandage only needs to be put on once. It seals the wound and may promote faster healing and lower infection rates. Also, it's water-proof.
Wash and dry the wound first. Then, put on the liquid. It comes with a brush or swab. It dries in less than a minute.
You can get this product at a drugstore near you. There are many brands of liquid bandage. No prescription is needed.
Bruises - Treatment:
Use a cold pack or ice bag wrapped in a wet cloth. Put it on the bruise once for 20 minutes. This will help to stop the bleeding.
After 48 hours, use a warm wet wash cloth. Do this for 10 minutes 3 times per day. This helps to reabsorb the blood.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Tetanus Shot:
A tetanus shot update may be needed for cuts and other open wounds.
Check your vaccine records to see when your child got the last one.
For Dirty Cuts and Scrapes. If last tetanus shot was given over 5 years ago, need a booster.
For Clean Cuts. If last tetanus shot was given over 10 years ago, need a booster.
See your child's doctor for a booster during regular office hours. It's safe to give it within 3 days or less.
What to Expect:
Small cuts and scrapes heal up in less than a week.
Call Your Doctor If:
Bleeding does not stop after using direct pressure to the cut
Starts to look infected (pus, redness)
Doesn't heal by 10 days
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Any rash on the skin covered by a diaper
Age: Diaper-wearing age group (birth to 3 years)
Causes of Diaper Rash
Irritant Diaper Rash. Mild rashes can be caused by the drying effect of soaps.
Stool Diaper Rash. Stool left on the skin can be very irritating because it contains bacteria. Urine alone has no germs in it and usually doesn't irritate the skin. This rash is common on the scrotum or anywhere that stool can hide. Small ulcers around the anus are often from prolonged stool contact.
Ammonia Diaper Rash. Stool and urine left in diaper too long can combine to make ammonia. It can cause a mild chemical burn. The fumes when you change the diaper will smell like ammonia. This is more common with cloth diapers.
Diarrhea Diaper Rash. Rashes just found around the anus are common during bouts of diarrhea. Diarrhea stools also contain enzymes that digest food and irritate the skin.
Yeast Diaper Rash. Rashes from irritants can get a secondary infection with yeast. Yeast infections are bright red. They can be raw and weepy. The borders are sharp. Small red bumps or even pimples may occur just beyond the border. If treated correctly, a diaper rash should be cured in 3 days. If not, it has probably been invaded by yeast. Treat with an anti-yeast cream.
Bacterial Diaper Rash. Bacteria can also cause a secondary infection of irritated skin. This is less common than yeast rashes. Bacteria cause sores, yellow scabs, pimples or draining pus. They look like impetigo, a local skin bacterial infection. Can also become a painful red lump (boil)
Cellulitis (Serious). The bacterial infection spreads into the skin. Gives redness that spreads out from the sore. The red area is painful to the touch.
Staph Scalded Skin Syndrome (Serious). SSSS is caused by a Staph bacteria. The main finding is widespread large blisters. The skin is bright red. The baby acts very sick.
Symptoms of Diaper Rash
Mild rashes just have areas of pink, dry skin.
Severe rashes have areas of red skin. In some areas, the skin may become raw or even bleed.
Pink rashes are not painful, but raw ones can be very painful. This can lead crying and poor sleep.
Prevention of Recurrent Diaper Rash
Change diapers more often. Focus on preventing skin contact with stool.
Rinse your baby's skin with lots of warm water when cleaning off stool. Don't depend on diaper wipes alone to cleanse the skin.
Be sure to clean stool off all the skin folds. Cleaning the scrotum can be a challenge.
When To Call
Call Doctor or Seek Care Now
Bright red skin that peels off in sheets
Fever and looks infected (spreading redness)
Age less than 1 month old with tiny water blisters or pimples in a group
Age less than 1 month old and looks infected (yellow scabs, spreading redness)
Age less than 1 month old and looks or acts abnormal in any way
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Any pimples, blisters, boils, yellow scabs, or open sores
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Rash is very raw or bleeds
Rash has spread outside the diaper area
Rash is not better after 3 days of using yeast cream
You have other questions or concerns
Self Care at Home
Mild diaper rash
Care Advice
What You Should Know About Diaper Rashes:
Diaper rashes are very common in babies.
Often caused by not cleaning stool off the skin soon enough.
Stool is a strong irritant to the skin.
Here's some care advice that should help.
Change More Often:
Change diapers more often to prevent skin contact with stool.
You may want to get up once during the night to change the diaper.
Rinse with Warm Water:
Rinse the baby's skin with lots of warm water during each diaper change.
Wash with a mild soap (such as Dove) only after stools. Reason: Using soap often can interfere with healing.
Do not use diaper wipes. Reason: They leave a film of bacteria on the skin.
Leave Bottom Open to Air:
Expose the bottom to air as much as possible.
Attach the diaper loosely at the waist to help with air exposure.
When napping, take the diaper off and lay your child on a towel. Reason: Dryness reduces the risk of yeast infections.
Anti-Yeast Cream:
Most diaper rashes respond to 3 days of warm water cleansing and air exposure. If you've tried this or the rash is bright red, suspect a yeast infection.
Buy an anti-yeast cream (such as Lotrimin.) No prescription is needed.
Use this cream 3 times per day.
Raw Skin - Treatment:
If the bottom is very raw, soak in warm water for 10 minutes. Add 2 tablespoons (30 mL) of baking soda to the tub of warm water.
Do this 3 times per day.
Then, put an anti-yeast ointment (such as Lotrimin) on the rash.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil). Avoid ibuprofen under 6 months of age.
Use as needed.
Age less than 3 months. Don't use pain medicines unless your doctor says it's okay. Have your child seen if the rash is causing a lot of pain.
Sore or Scab on End of the Penis Treatment:
Use an antibiotic ointment (such as Polysporin). No prescription is needed.
Do this 3 times per day.
Reason: The sore is a bacterial infection that can cause painful urination.
Diarrhea Rash - Use Protective Ointment:
If your child has diarrhea and a rash around the anus, use a protective ointment. Examples are Vaseline or Desitin.
This forms a barrier between the skin and the stool.
Otherwise, these generally are not needed.
Caution: Wash off the skin before putting it on.
What to Expect:
With proper treatment, most diaper rashes are better in 3 days.
If the rash does not respond, a yeast infection has probably occurred.
Call Your Doctor If:
Rash isn't much better after 3 days of using yeast cream
It starts to look infected (with sores and scabs)
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Cracked skin or dry, rough skin
Cracked skin on hands, feet and lips
Dry, rough skin of entire body surface
Causes of Cracks in the Skin
Most cracked skin is found on the feet, hands or lips.
Feet. The soles of the feet are most commonly involved. Most often, cracks occur on the heels and big toes. This is called tennis shoe dermatitis. Deep cracks are very painful and can bleed. The main cause is wearing wet or sweaty socks or swimming a lot.
Hands. Cracks can develop on the hands in children. The main cause is washing the hands too much or washing dishes. Can also occur from working outside in winter weather. The worse cracks of the fingers occur with thumb sucking.
Lips. The lips can become chapped in children from the sun or wind. If the lips become cracked, it's usually from a "lip-licking" habit. The skin around the lips can also become pink and dry. This occurs especially in children who suck on their lips.
Causes of Dry Skin
Dry skin is a common condition.
Soap. Dry skin is mainly caused by too much bathing and soap (soap dermatitis). Soap removes the skin's natural protective oils. Once they are gone, the skin can't hold moisture.
Climate. Dry climates make dry skin worse, as does winter weather (called winter itch).
Genetics also plays a role in dry skin.
Dry skin is less common in teenagers than younger children. This is because the oil glands are more active.
Keratosis Pilaris - dry, rough, bumpy skin on the back of the upper arms. It's made worse by soaps. Treat with moisturizing creams.
Pityriasis Alba - dry pale spots on the face. These are more prevalent in the winter time and are also made worse by soaps. Treat with moisturizing creams.
Eczema. Children with eczema have very dry itchy skin.
Liquid Skin Bandage For Deep, Chronic Cracks
Liquid plastic skin bandage is a new product that seals wounds. It is a plastic coating that lasts up to 1 week.
It is the best way to relieve pain and promote healing. As the crack heals from the bottom upward, it pushes the plastic seal up.
After the wound is washed and dried, put the liquid on. It comes with a small brush or with a swab. It dries in less than a minute. Then apply a second coat. It's waterproof and may last a week.
You can buy this at any drug store. Many brands of liquid bandage are available. No prescription is needed.
When To Call
Call Doctor or Seek Care Now
Fever and looks infected (spreading redness)
Cracked red lips and fever lasts 5 days or more
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Looks infected (pus or spreading redness)
Bleeding from cracked lips
Cracks on feet that make it hard to walk
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Cracks from thumb-sucking or finger-sucking
Peeling skin and cause is not clear
After 2 weeks of treatment, cracked lips are not healed
After 2 weeks of treatment, cracked skin is not healed
After 2 weeks of treatment, dry skin is still itchy
You have other questions or concerns
Self Care at Home
Cracked skin on the feet
Cracked skin on the hands
Chapped lips
Dry, itchy skin caused by soap or cold/dry weather
Care Advice
Treatment for Cracked Skin on the Feet
What You Should Know About Cracks on Feet:
Most often, cracked skin of the feet is caused by repeated contact with moisture.
The main cause is often wearing wet (or sweaty) socks. Swimmers also have this problem.
The soles of the feet are most often involved. Usually, you see cracks on the heels and big toes.
This is called tennis shoe or sneaker dermatitis.
Cracked, dry feet usually can be treated at home.
Here is some care advice that should help.
Shallow Cracks - Use Ointment:
Cracks heal faster if protected from air exposure and drying.
Keep the cracks constantly covered with petroleum jelly (such as Vaseline). Put it on the cracks 3 times a day.
If the crack seems mildly infected, use an antibiotic ointment instead (such as Polysporin). No prescription is needed. Put it on the cracks 3 times a day.
Covering the ointment with a bandage (such as Band-Aid) speeds recovery. You can also cover it with a sock.
Option: If you have it, a liquid skin bandage works even better. Don't use liquid bandage and ointment together.
Deep Cracks - Use Liquid Skin Bandage:
Deep cracks of the feet or toes usually do not heal with ointments.
Use a liquid skin bandage that will completely seal the crack. Many brands of liquid bandage are available. No prescription is needed.
Start with 2 layers. Put on another layer as often as needed.
As the crack heals, the plastic layer will be pushed up.
Prevention of Cracks on Feet:
Change socks whenever they are wet or sweaty.
Take an extra pair of socks to school.
When practical, do not wear shoes. Go barefoot or wear socks only.
Do not use bubble bath or other soaps in the bath water. Soaps take the natural oils out of the skin.
Use a moisturizing cream on the feet after baths or showers.
Wear shoes that allow the skin to "breathe."
What to Expect:
Most cracks heal over in 1 week with treatment.
Deep cracks heal if you keep them covered all the time with crack sealer. Deep cracks will heal in about 2 weeks with crack sealer.
Call Your Doctor If:
Starts to look infected (redness, red streak, pus)
Cracks last more than 2 weeks on treatment
You think your child needs to be seen
Your child becomes worse
Treatment for Cracked Skin on the Hands
What You Should Know About Cracks on Hands:
Cracked skin of the hands is usually caused by repeated contact with moisture.
Examples are washing dishes or washing the hands often.
Soap removes the natural protective oils from the skin.
Cracked, dry hands usually can be treated at home.
Here is some care advice that should help.
Shallow Cracks - Use Ointment:
Cracks heal faster if protected from air exposure and drying.
Keep the cracks constantly covered with petroleum jelly (such as Vaseline). Put it on the cracks 3 times a day.
If the crack seems mildly infected, use an antibiotic ointment instead (such as Polysporin). No prescription is needed. Put it on the cracks 3 times a day.
Covering the ointment with a bandage (such as Band-Aid) speeds recovery. You can also cover it with a glove.
Option: If you have it, a liquid skin bandage works even better. Don't use liquid bandage and ointment together.
Deep Cracks - Use Liquid Skin Bandage:
Deep cracks of the fingers usually do not heal with ointments.
Use a liquid skin bandage that will completely seal the crack. Many brands of liquid bandage are available. No prescription is needed.
Start with 2 layers. Put on another layer as often as needed.
As the crack heals, the plastic layer will be pushed up.
Prevention of Cracks on Hands:
Wash the hands with warm water.
Use soap only if the hands are very dirty. Also, use soap for anything that won't come off with water.
Wear gloves when washing dishes.
During cold weather, wear gloves outside.
Use a moisturizing cream on the hands after anytime they have been in water.
What to Expect:
Most cracks heal over in 1 week with treatment.
Deep cracks heal if you keep them covered all the time with crack sealer. Deep cracks will heal in about 2 weeks with crack sealer.
Call Your Doctor If:
Starts to look infected (redness, red streak, pus)
Cracks last more than 2 weeks on treatment
You think your child needs to be seen
Your child becomes worse
Treatment for Chapped Lips
What You Should Know About Chapped Lips:
The lips can become chapped in children from too much sun or wind.
If the lips become cracked, it's usually from a "lip-licking" habit.
The skin around the lips can also become pink and dry. This occurs especially when children suck on their lips.
Here is some care advice that should help.
Lip Balm:
A lip balm should be used often, even hourly.
Be sure to put it on after eating or drinking.
Avoid "Lip-Licking":
Help your child give up the habit of lip-licking or sucking.
This habit usually is not seen before age 6.
This habit will only change if you can gain your child's active participation.
Appeal to your child's pride. Show your child in a mirror how lip-sucking has affected their appearance.
Give them a lip lubricant to put on their lips. Tell them to use it when they feel the urge to suck on them. Another option is to replace lip-sucking with chewing gum.
Offer an incentive for going an entire day without lip-sucking. Examples of rewards are money or points towards a prize.
Avoid any pressure or punishment. It will backfire, cause a power struggle and make the habit last longer.
Call Your Doctor If:
Starts to look infected (redness, red streak, pus)
Cracks last more than 2 weeks on treatment
You think your child needs to be seen
Your child becomes worse
Treatment for Dry or Itchy Skin
What You Should Know About Dry Skin:
Dry skin is a common condition.
Mainly caused by too much bathing and soap (soap dermatitis).
Soap removes the skin's natural protective oils. Once they are gone, the skin can't hold moisture.
Dry climates make it worse, as does winter weather (called winter itch).
Genetics also plays a role in dry skin.
Dry skin is less common in teenagers than younger children. This is because the oil glands are more active in teens.
Here is some care advice that should help.
Bathing - Avoid Soap:
Young children with dry skin should avoid all soaps. Soaps take the natural protective oils out of the skin. Bubble bath does the most damage.
For young children, the skin can be cleansed with warm water alone. Keep bathing to 10 minutes or less.
Most young children only need to bathe twice a week.
Teenagers can get by with using soap only for the armpits, genitals, and feet. Also, use a mild soap (such as Dove).
Do not use any soap on itchy areas or rashes.
Moisturizing Cream:
Buy a large bottle of moisturizing cream (such as Eucerin). Avoid those with fragrances.
Put the cream on any dry or itchy area 3 times per day.
After warm water baths or showers, trap the moisture in the skin. Do this by putting on the cream everywhere after bathing. Use the cream within 3 minutes of completing the bath.
During the winter, apply the cream every day to prevent dry skin.
Steroid Cream:
For very itchy spots, use 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
Use up to 3 times per day as needed until the itching is better.
Eventually, the moisturizing cream will be all that you need for treating dry skin.
Humidifier:
If your winters are dry, protect your child's skin from the constant drying effect.
Do this by running a room humidifier full time.
Preventing Dry Skin:
Don't use soaps or bubble bath.
Wash the hands with warm water. Use soap only if the hands are very dirty. Also, use soap for anything that won't come off with water.
Don't use swimming pools or hot tubs. Reason: Pool chemicals are very drying.
Run a humidifier in the winter if the air is dry.
During cold weather, wear gloves outside. This helps prevent drying of the skin.
Drink lots of fluids.
Call Your Doctor If:
Dry skin lasts more than 2 weeks on treatment
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
An itchy rash that your doctor told you was eczema
Eczema is a chronic skin disease
Recurrent flare-ups of severe itching occur
The medical name for eczema is atopic dermatitis
Symptoms of Eczema
The main symptom is itching. If it doesn't itch, it's not eczema.
With flare-ups (itching attacks), the rash becomes red or even raw and weepy.
Onset: Average onset at 3 months old. Range: 1-6 months old. Usually begins by 2 years old.
Location: Classic eczema starts on the cheeks at 1 to 6 months of age. It can spread to the rest of the face. In infants, the outer surfaces of the arms and legs also become involved.
In older children, eczema is found in the joint creases. The elbows, wrists, and knees are the most common places.
The rash is usually the same on both sides of the body.
Cause of Eczema
A type of dry, sensitive skin that children inherit.
Flare-ups are from skin contact with soap, shampoo, pollen or other irritating substances.
About 30% of babies with severe eczema also have food allergies. The most common is cow's milk.
Over 10% of children have eczema. It's the most common skin condition of the first 10 years.
Triggers of Eczema Flare-Ups
Soaps. Never use bubble bath. It can cause a major flare-up.
Pollens. Keep your child from lying on the grass during grass pollen season.
Animals. Avoid any animals that make the rash worse.
Foods. If certain foods cause severe itching (flares), avoid them.
Wool. Avoid wool fibers and clothes made of other scratchy, rough materials.
Dry Air. Use a humidifier if the air in your home is dry.
Herpes Virus Infection (Serious). Keep your child away from anyone with fever blisters (cold sores). The herpes virus can cause a serious skin infection in children with eczema.
Eczema is not caused by laundry soap you use to wash clothing.
Itching Scale
Mild: doesn't interfere with normal activities
Moderate: interferes with child care or school, sleep, or other normal activities
Severe: constant itching that can't be controlled
Food Allergy and Eczema Flare-Ups
Food allergies are a factor in 30% of young children with severe eczema. This factor is mainly seen in babies.
The main allergic foods are cow's milk and eggs.
The main symptoms are increased skin redness and itching. Some parents report these symptoms start during or soon after the feeding.
The eczema becomes easier to control if you avoid the allergic food.
Diagnosing Food Allergy and Eczema Flare-Ups
Your child's doctor may suggest the steps listed below:
Remove the suspected food or foods from your child's diet for 2 weeks. The eczema should greatly improve.
Then give your child that food when the eczema is under good control. This is called a "challenge."
If the food is causing flare-ups, the eczema should become itchy and red. The flare-up should occur quickly within 2 hours of eating the food.
If this occurs, avoid giving this food to your child. Talk to your child's doctor about the need for any food substitutes.
If the eczema does not flare-up, your child isn't allergic to that food.
When To Call
Call 911 Now
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.
Looks infected (spreading redness, pus, soft oozing scabs) and fever
Many small blisters or punched-out sores occur
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Eczema is very painful to touch
Looks infected but no fever
Itching is severe after using steroid cream for more than 48 hours
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Itching flare-ups occur often
Eczema diagnosis was never confirmed by a doctor
You have other questions or concerns
Self Care at Home
Eczema with no other problems
Questions about prevention of eczema flare-ups
Care Advice
Treatment for Eczema
What You Should Know About Eczema:
Eczema is a chronic skin disease. So, you need to learn how to control it.
Itching attacks (flare-ups) are to be expected.
The goal is to treat all flare-ups quickly. Reason: To prevent skin damage.
Here is some care advice that should help.
Treatment is Based on Severity of Eczema:
Mild Eczema. Just need to use a moisturizing cream and to avoid flare-up triggers.
Moderate Eczema. Also need to use a steroid cream and bedtime allergy medicine.
Severe Eczema. Also may need antibiotics for a skin infection caused by Staph bacteria. This infection starts in open skin from severe itching.
Moisturizing Cream or Ointment for Dry Skin:
All children with eczema have dry sensitive skin.
The skin needs a moisturizing cream (such as Eucerin) Apply once or twice daily.
Apply the cream after a 5 or 10-minute bath. To trap moisture in the skin, apply the cream while skin is still damp. Do this within 3 minutes of leaving the bath or shower.
The steroid cream should be applied to any itchy spots first. Then use the moisturizing cream as the top layer.
While most parents prefer creams, moisturizing ointments are sometimes needed in the winter. An example is Vaseline.
Caution: Never stop the moisturizing cream. Reason: The rash will come back.
Steroid Cream or Ointment for Itching:
Itchy skin is the main symptom of eczema.
Steroid creams or ointments are essential for controlling red, itchy skin.
Apply steroid creams only to itchy or red spots (not to the normal skin).
Most children have 2 types of steroid creams. (1) A mild steroid cream is used to treat any pink spots or mild itching. This is often 1% hydrocortisone cream (such as Cortaid). No prescription is needed. (2) Another stronger steroid cream is needed to treat any spots with severe itching. This is a prescription steroid cream such as Synalar. Never apply this stronger cream to the face.
Apply these creams as directed or 2 times per day.
After the rash quiets down, apply it once per day. After 1 good week just use moisturizing cream.
Bathing - Avoid Soaps:
Give one bath a day for 10 minutes in lukewarm water. Reason: Water-soaked skin feels less itchy. Follow the bath with a moisturizing cream (such as Eucerin) to all the skin.
Avoid all soaps. Reason: Eczema is very sensitive to soaps, especially bubble bath. There is no safe soap for young children with eczema. They can be cleaned using warm water.
Allergy Medicine for Itching at Bedtime:
Many children with eczema need an allergy medicine by mouth at bedtime.
Reason: Scratching in bed can cause severe skin breakdown. It may also interfere with falling sleep.
Give the med your child's doctor wanted you to use for itching.
If none was suggested, you can try Benadryl at bedtime. No prescription is needed.
Caution: Do not use if age is under 1 year. Reason: Benadryl is a sedative. Give your doctor a call for advice.
Itching Attack - Shower to Remove Irritants:
Playing in the grass, being around animals, or swimming can cause increased itching.
For itching from these causes, give your child a quick shampoo and shower.
Itching Attack - Treatment:
At the first sign of any itching, use the steroid cream. Put it on the areas that itch. If unsure, apply 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
Keep your child's fingernails cut short and smooth.
Ask older children to try not to itch, but never punish for itching.
For constant itching in young children, cover the hands with socks or gloves. Use for a day or until the itching is brought under control. Provide extra cuddling during this time.
Return to School:
Eczema cannot be spread to others.
Children with eczema do not need to miss any child care or school.
What to Expect:
Eczema is a chronic condition. Around the teen years, about half get over their eczema.
Many children who have severe eczema as babies develop asthma and nasal allergies.
Call Your Doctor If:
Itching is not under control after 2 days of steroid cream
Rash looks infected (spreading redness, yellow scabs or pus)
You think your child needs to be seen
Your child becomes worse
Prevention of Eczema Flare-Ups
Tips to Help Prevent Flare-Ups:
Some flare-ups of eczema cannot be explained. But others are triggered by things that can be avoided.
Avoid chlorine in swimming pools and spas, harsh chemicals, and soaps.
Never use bubble bath. It can cause a major flare.
Keep your child off the grass during grass pollen season.
Avoid any animals that make the rash worse.
If certain foods cause severe itching (flares), avoid them.
Wear clothes made of cotton or cotton blends as much as possible. Avoid wool fibers and clothes made of other scratchy, rough materials. They make eczema worse.
Try to avoid excess heat, excess cold and dry air (use a humidifier). Avoid over-dressing. Heat can make the rash worse.
Caution: Keep your child away from anyone with fever blisters (cold sores). The herpes virus can cause a serious skin infection in children with eczema.
Call Your Doctor If:
You have other questions or concerns
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Viral rash that starts with red cheeks and spreads to the shoulders
Symptoms of Fifth Disease
Bright red cheeks on both sides for 1 to 3 days. Looks like "slapped cheeks".
Followed by pink "lace-like" (net-like) rash of arms and legs.
"Lacy" rash mainly is on thighs and upper arms/shoulders.
Rash also is on chest and stomach in 50% of children.
The rash does not itch or hurt.
No fever or low-grade one less than 102° F (39° C).
Peak age: 4 -12 years.
Cause of Fifth Disease
It is caused by the human parvovirus B19.
Not related to the dog parvovirus.
Prevent Spread to Others
Good hand washing can prevent spread of this illness.
Once the rash occurs, the child can no longer spread the virus.
When To Call
Call 911 Now
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Only 1 cheek is red and also has fever
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Fever over 102° F (39° C)
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Sore throat lasts more than 48 hours
Mother or other caregiver is pregnant
You have other questions or concerns
Self Care at Home
Fifth disease suspected
Care Advice
What You Should Know About Fifth Disease:
It is a viral rash that is harmless.
It does not itch or hurt.
It can be treated at home.
Here is some care advice that should help.
Fever Medicine:
For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Note: Fevers less than 102° F (39° C) are important for fighting infections.
For all fevers: Keep your child well hydrated. Give lots of cold fluids.
Pregnant Women - Special Risk:
The risk of Fifth disease is to the unborn babies of pregnant women. It is not harmful to the woman herself.
A pregnant woman should see her doctor if she is exposed.
He will do a test to see if the mother has had the disease. If she has, she is protected.
If not, the pregnancy will need to be watched closely. Some babies that get it before birth can have problems. Ten percent can have a very low red blood cell count and 2% may die.
But, birth defects are never a result of this virus.
What to Expect:
The lace-like rash can come and go for 1 to 3 weeks.
Return to School:
Once your child has the "slapped cheeks", they can no longer spread the illness. Also, the lacy rash cannot be spread to others either.
Your child does not need to stay home from child care or school.
It can be spread during the week before the rash begins.
Exposed children should try not to have any contact with pregnant women. This may be hard to know ahead of time.
Call Your Doctor If:
Fever above 102° F (39° C) occurs
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Stung by a fire ant
Fire ant stings are more common in the Southern U.S.
Local Skin Reactions to the Sting
The main symptoms are pain, burning, swelling and redness at the sting site.
Pain. Pain and burning at the site usually lasts 10 minutes. The pain is far less than that of a bee sting.
Itching. Itching follows the pain and can last for weeks.
Hive. Hive-like bump occurs at sting site within 30 minutes (100%). This looks like a red spot with raised white center.
Pimples. Pimples with yellow fluid (pustules) occur at the sting site within 24 hours (96%). These pimples are almost diagnostic for fire ant stings. They are very itchy. They usually open on their own by 3 days. Then, they dry over. Sometimes, they can last for up to a week.
Normal Swelling. Normal swelling from venom can increase for 24 hours after the sting. Stings of the upper face can cause severe swelling around the eye. This is harmless.
Severe Swelling. Sometimes, fire ant bites can cause severe swelling. Hand or foot bites can cause swelling that crosses the wrist (or ankle). The degree of swelling can interfere with function and need steroids. These do not carry an increased risk of allergic reaction with future stings.
Redness. Stings can become red. This is normal. That doesn't mean they are infected. Infections rarely occur in stings.
Anaphylactic Reaction to the Sting
A severe life-threatening allergic reaction is called anaphylaxis.
The main symptoms are hives with trouble breathing and swallowing. It starts within 2 hours of the sting.
This severe reaction to fire ant stings happens in 1 to 2% of children.
Hives. After fire ant stings, some children just develop hives all over or face swelling. Hives or face swelling alone may be able to be treated at home. But, at times, these symptoms can also lead to anaphylaxis. Be sure to call your doctor now to help decide.
Cause of Fire Ant Sting Reactions
The ant's stinger injects venom into the skin.
The venom is what causes all the symptoms.
A fire ant attaches to the skin with its jaws and swivels its body. It stings multiple times with its back stinger.
One fire ant can leave a semi-circular pattern of more than one sting.
General Information About Fire Ants
In infested areas, fire ants cause many more stings than bees or yellow jackets.
Over 50% of people living in these areas are stung each year.
Fire ants are found throughout the Southern U.S., from Florida to Texas. They have also appeared in California, New Mexico and Arizona.
Colonies of fire ants live in small mounds of dirt, usually 6 inches tall.
When the mound is disturbed, hundreds of fire ants stream out and attack.
The fire ant causes a "burning" feeling at the site of the stings. This is how it got its name.
Prevention of Fire Ant Stings
The only way to prevent fire ant stings is to avoid their colonies.
Teach your children to know their colonies (mounds) and to keep their distance.
Insect repellents (including those that have DEET) don't help to prevent fire ant stings.
Wear socks. Fire ants cannot bite through socks.
When To Call
Call 911 Now
Past severe allergic reaction to fire ant stings (not just hives) and stung less than 2 hours ago
Wheezing or trouble breathing
Hoarseness, cough or tightness in the throat or chest
Trouble swallowing or drooling
Speech is slurred
Acts or talks confused
Passed out (fainted) or too weak to stand
You think your child has a life-threatening emergency
Go to ER Now
Hives or swelling all over the body
Call Doctor or Seek Care Now
Sting inside the mouth
Sting on the eye
Stomach pain or vomiting
Age less than 1 year with 20 or more stings. Newborn if more than 5.
More than 5 stings for 10 pounds (5 kg) of weight. In teens, more than 50 stings.
Fever and sting looks infected (spreading redness)
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Painful spreading redness started more than 24 hours after the bite. Note: any redness starting in the first 24 hours is a reaction to the bite.
More than 48 hours since the sting and redness getting larger
Swelling is huge (4 inches or 10 cm). It spreads across a joint such as the wrist.
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Scab that looks infected (drains pus or gets bigger) not better with antibiotic ointment
Severe itching not better after 24 hours of using steroid cream
You have other questions or concerns
Self Care at Home
Normal reaction to a fire ant sting
Care Advice
What You Should Know About Fire Ant Stings:
Pain from a fire ant sting is less severe than with a bee sting. Most often, it's gone in 10 minutes.
Fire ant stings form a pimple and become red. This is normal. That doesn't mean they are infected.
Here is some care advice that should help.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Steroid Cream for Itching:
For relief of itching, use 1% hydrocortisone cream (such as Cortaid). Use 3 times per day. No prescription is needed.
Allergy Medicine for Itching:
For severe itching or swelling, give Benadryl by mouth. No prescription is needed.
Use 3 times per day as needed.
Pustules (Pimples) - Do Not Open:
By 24 hours, a small blister will form over the sting.
Do not open them.
Try not to scratch them.
If you open the blisters, they often become infected.
Left alone, they will most likely dry up in 4 days.
Antibiotic Ointment:
If the pimples break open, use an antibiotic ointment (such as Polysporin.) No prescription is needed.
Use 3 times per day to prevent skin infections. Keep using it for 1 or 2 days.
What to Expect:
Severe pain or burning at the site lasts 5 to 10 minutes.
Itching follows the pain and is the main symptom. It can last a week.
Swelling: Normal swelling from ant venom can increase for 24 hours after the sting.
The redness can last 3 days and the swelling 7 days.
Call Your Doctor If:
Redness lasts over 3 days
Swelling becomes huge or spreads past the wrist or ankle
Sting begins to look infected (redness gets larger after 48 hours)
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Allergic reactions to foods
The most common symptom is hives
Questions about food allergies
Oral Allergy Syndrome is also covered. The main symptom is mouth itching and swelling. The main triggers are raw fruits and veggies.
Symptoms of Food Allergies
Hives all over and swelling of the face are the most common symptoms. Hives are raised pink bumps with pale centers (welts). They look like bug bites.
Mouth itching and swelling
Runny nose and coughing
Vomiting and diarrhea
Life-threatening allergic reactions also must have trouble breathing and/or swallowing. The medical name for this is anaphylaxis. Most of these reactions have a sudden onset within 10 to 20 minutes. All occur within 2 hours of eating a certain food. People who have had this carry an emergency kit like an Epi-Pen.
Causes of Food Allergies
8 foods cause 90% of food allergies
In the first year of life: cow's milk, soy milk and egg
Older children: peanuts, tree nuts, fish, shellfish and wheat
Shellfish include shrimp, crab, lobster, clams, oysters and scallops
Tree nuts include all the nuts (such as almonds and cashews) except peanuts.
Of children with a proven food allergy, 40% have severe reactions. The other 60% have mild reactions.
Peanuts and tree nuts are the most common triggers for severe reactions.
Cross Reactions With Other Foods
Children with allergies listed below can react to other foods:
Cow's milk allergy: 90% also react with goat's milk and 40% with soy milk
Egg: 5% react with chicken
Peanut: 5% react with other legumes (like peas or beans). About 30% also react to tree nuts.
Tree nut : 40% react with other tree nuts
Fish: 50% react with other fish. Only 10% also react to shellfish.
Shellfish: 70% react with other shellfish
Melon: 90% react with banana and avocado
How Long do Food Allergies Last?
Cow's milk: 80% outgrown by age 16
Soy milk: 80% by age 16
Egg: 70% by age 16
Peanut: 20% by age 16
Tree nut: 10% by age 16
Allergic Disease - Can You Prevent with Diet?
Most allergic diseases (food allergies, eczema and asthma) cannot be prevented.
Helpful: Feeding only breastmilk for 4 months or longer
Not helpful: Avoiding high-risk foods for pregnant or breastfeeding women
Not helpful: Soy formulas instead of cow's milk formula
Not helpful: A delay in starting baby foods past 6 months
Not helpful: A delay in starting high-risk foods like peanut butter or eggs
Source: AAP
Oral Allergy Syndrome (OAS)
A minor reaction to some raw fruits and veggies
Causes itching and swelling only to the lips and tongue
Also called Pollen-Food Syndrome
Symptoms of OAS
Rapid onset of itching (or tingling) and swelling of the mouth.
This can involve the lips, tongue, throat, and roof of the mouth.
The uvula (tag of tissue hanging down in back) can become very swollen.
These symptoms follow eating a high risk raw fruit or veggie.
OAS can start by age 5.
Serious symptoms or very bad reactions rarely happen.
Causes of OAS
A contact allergy. It only involves the parts of the mouth that touch the raw food.
Trigger foods for OAS are always raw (not cooked.)
Fresh Fruits. These include apple, apricot, banana, cherry, melons, orange, peach and pear.
Raw Veggies. These include carrot, celery, parsley, potato and tomato. Carrots and celery have the highest risk for also causing serious symptoms.
Certain Seeds. These include sunflower seeds and fennel seeds.
OAS and Nose Allergies Can Be Linked
Over 50% of people who are allergic to pollen also have OAS. This means 10% of all people.
Ragweed pollen allergy can cross-react with all melons. Also, sometimes with bananas and tomatoes.
Birch pollen allergy can cross-react with raw potatoes, carrots, celery and apples.
Grass pollen allergy can cross-react with tomato and kiwi.
When To Call
Call 911 Now
Life-threatening allergic reaction to similar food in the past. Food eaten less than 2 hours ago.
Trouble breathing or wheezing
Hoarse voice or cough start all of a sudden
Trouble swallowing, drooling or slurred speech start all of a sudden
You think your child has a life-threatening emergency
Go to ER Now
Hives all over start within 2 hours after eating a high-risk food. High-risk foods include nuts, fish, shellfish, or eggs.
Major face swelling (not just lips) starts within 2 hours of eating high-risk food
Vomiting or stomach cramps starts within 2 hours of eating high-risk food
Call Doctor or Seek Care Now
Hives all over start 2 to 4 hours after eating high-risk food. High-risk foods include nuts, fish, shellfish, or eggs.
Major face swelling (not just lips) starts 2 to 4 hours after eating high-risk food
Vomiting or stomach cramps starts 2 to 4 hours after eating high-risk food
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Other symptoms that might be from a food allergy and present now
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Recurrent symptoms that might be from a food allergy but not present now
Oral Allergy Syndrome suspected but never confirmed by a doctor
Food allergy diagnosed and you want to restart that food
You have other questions or concerns
Self Care at Home
Food allergy: mild reaction
Oral allergy syndrome
Care Advice
Treatment of a Food Allergy
What You Should Know About Food Allergies:
About 5% of children have food allergies.
Most children with a new food reaction need to be seen.
If your child is stable, hives often can be treated at home.
Hives as the only symptom can have many causes.
Your child can be seen later to decide future risks and best treatment.
Here is some care advice that should help.
Benadryl:
Give Benadryl 4 times per day for hives all over. No prescription is needed.
If you only have another allergy med at home (but not Benadryl), use that. Follow the package directions.
Use the Benadryl 4 times per day until the hives are gone for 12 hours.
Caution: Do not use if age is under 1 year. Reason: Benadryl makes most children sleepy. Give your doctor a call for advice.
Cool Bath for Itching:
To help with any itching, can also give a cool bath. Do this for 10 minutes.
Caution: Do not cause a chill.
How to Prevent Future Reactions:
Help your child avoid the food that caused the symptoms.
Read labels on all food products fully.
Tell other people who care for your child of your child's food allergy. Also, inform the staff at your child's school.
Learn more at Food Allergy Research and Education.
What to Expect:
Hives from foods often last just a short time.
They often are gone in less than 6 hours.
Return to School:
Hives cannot be spread to others.
Your child can go back to school once feeling better. The hives shouldn't keep him from doing normal things.
Call Your Doctor If:
Trouble breathing occurs
Trouble swallowing or drooling occurs
Severe hives not better after 2 doses of Benadryl
Hives last over 24 hours
You think your child needs to be seen
Your child becomes worse
Treatment of Oral Allergy Syndrome Symptoms
What You Should Know:
Oral Allergy Syndrome (OAS) is very common. It happens in 10% of people. Most of them also have pollen allergies.
The symptoms are not harmful and can be treated at home.
Needed for OAS: Your child has never had any serious symptoms with this food.
OAS symptoms don't last very long.
Here is some care advice that should help.
Rinse the Mouth:
Rinse the lips and mouth with warm water. Do this a few times.
Reason: To remove any traces of the food.
Cold Pack:
Use ice or a cold pack to the swollen lips or tongue for 10 minutes.
Reason: To lessen the swelling and the itch.
Benadryl:
One dose of Benadryl may help the symptoms go away faster.
No prescription is needed.
If you only have another allergy med at home (but not Benadryl), use that. Follow the package directions.
How to Prevent Future OAS:
Keep a list of the foods that cause your child's symptoms.
Avoid these foods if they are raw (fresh).
The cooked version of these foods usually won't cause any symptoms.
What to Expect:
With or without treatment, the itching will go away in 1 to 2 hours.
The mouth swelling will also go away quickly.
Call Your Doctor If:
Trouble swallowing or drooling occurs
Trouble breathing occurs
Swelling or rash occurs anywhere else
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Frostbite is a cold injury to the skin
Symptoms of Frostbite
Symptoms of mild frostbite (or frostnip) are cold, tingling and painful skin.
True frostbite causes white, hard, numb skin. It can be serious. It always needs medical care after re-warming.
Common sites are toes, fingers, tip of the nose, the outer ear or cheeks.
Cause of Frostbite
The nerves, blood vessels and skin cells are frozen for a short time.
The ears, nose, fingers, and toes are most often affected.
Frostbite Severity - Frostbite can be classified like burns:
Frostnip (mild frostbite). Cold, tingling and painful skin. No skin changes after re-warming.
1st Degree. White and waxy (hard) while frozen. Mild redness and swelling after re-warming. No blisters.
2nd Degree. Same as 1st degree plus blisters after 24 hours.
3rd Degree. Blood-filled blisters leading to skin damage and scarring.
Hypothermia
Frostbite and hypothermia are two different medical problems.
Frostbite results from a cold injury to the skin. The body's core temperature can be normal.
In contrast, hypothermia signals a marked decrease in the body's core temperature. Frostbite may or may not occur. Hypothermia is defined as a body temperature less than 95° F (35° C) rectally. It can be deadly without intervention.
Factors Leading to Frostbite
Medical Conditions. Patients with diabetes, Raynaud's disease, and previous frostbite are all at greater risk.
Type of Contact. Frostbite is made worse if the skin and clothing are wet. Touching bare hands to cold metal during freezing weather can cause frostbite right away.
Time of Contact. The longer the exposure, the greater the heat loss and the chance of frostbite. The wind-chill index also plays a part in how quickly frostbite occurs.
When To Call
Call 911 Now
Can't wake up
Speech is slurred
Acts or talks confused
Stumbling or falling
Body temperature is less than 95° F (35° C) rectally
Body temperature is less than 94° F (34.4° C) by mouth
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
You think your child has a serious injury
White, hard, numb skin (before rewarming)
Skin color and feeling does not return to normal after 1 hour of rewarming
Severe shivering still present after re-warming and drying
Severe pain still there after rewarming and taking pain medicine
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Frostbite skin gets blisters
Blisters start to look infected (spreading redness or pus)
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Mild frostbite
Care Advice
What You Should Know About Frostbite:
Frostbite means the nerves and skin were frozen for a short time.
Most frostbite is mild. Most often, it gets better with warming up.
Here is some care advice that should help.
Rewarming With Wet Heat:
Move into a warm room.
For Frostbite of Fingers or Toes. Place the body part in warm water. A bathtub or sink is often the best method. The water should be very warm (104° to 108° F, or 40° to 42° C). It should not be hot enough to burn. Keep soaking in the warm water for about 30 minutes. A pink flush means circulation has returned to the body part. At this point, the numbness should be gone.
For Frostbite of the Face (such as ears, nose). Put a warm wet washcloth on the area. You should keep doing this for about 30 minutes. A pink flush means circulation has returned to the area.
With more severe frostbite, the last 10 minutes of rewarming can be painful.
If not using a tub, keep the rest of your child's body warm. Cover with blankets.
Common Treatment Mistakes:
A common mistake is to put snow on the frostbitten area or to rub it. Both can cause damage to thawing tissues.
Do not re-warm with dry heat. Do not use heat lamps, heating pads or electric heaters. Reason: Skin that has frostbite can't sense burning.
Do not re-warm if could freeze again in the next few hours. Freezing-warming-freezing causes more harm than freezing-warming.
Drink Warm Liquids:
Have your child drink lots of warm liquids such as hot chocolate.
Ibuprofen For Pain:
For true frostbite, give an ibuprofen product (such as Advil) for pain relief.
Aloe Vera Ointment for Pain:
Put aloe vera ointment on the frostbite.
Use twice daily for 5 days.
What to Expect:
Frostnip does not cause any damage to the skin. After rewarming, skin feeling, color and softness come back in less than 1 hour.
Mild frostbite: After rewarming, the skin may be flushed and tingly. This lasts for a few hours.
Prevention of Frostbite: (especially important in children with previous frostbite)
Cold sensitivity and recurrent frostbite is common following severe frostbite.
Dress in layers for cold weather. The first layer should be thermal underwear. The outer layer needs to be waterproof. The layers should be loose, not tight. Mittens are warmer than gloves. Do not use tight gloves or shoes. They might interfere with circulation.
Wear a hat, because over 50% of heat loss occurs from the head.
Change wet gloves or socks right away.
Teach your child to know the first warning signs of frostbite. Tingling and numbness are signs to go indoors.
Call Your Doctor If:
Color and feeling do not return to normal after 1 hour of re-warming
Frostbite gets blisters
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Tiny red spots and water blisters on the hands and feet caused by a virus
Rash is seen on the palms, fingers, soles and toes
The diagnosis cannot be made without these
Also can cause small mouth ulcers (sores)
Symptoms of Hand-Foot-and-Mouth Disease (HFMD)
Small red spots and tiny water blisters on the hands and feet. Seen on the palms, fingers, soles and toes.
The diagnosis cannot be made without these.
Small painful ulcers (sores) in the mouth. Look for them on the tongue and sides of mouth. Most children with HFMD have these, but they can be hard to see.
Also, small blisters or red spots on the buttocks (30%)
Low-grade fever less than 102° F (39° C)
Mainly occurs in children age 6 months to 4 years
Cause of HFMD
Coxsackie A-16 virus and other enteroviruses
Not related to any animal disease
Severe Form of HFMD
Since 2012, a severe form of HFMD has occurred in much of the world. It's caused by a new Coxsackie A6 virus.
The rash spreads to the arms, legs and face. The rash is made up of many small blisters.
Children with such a severe rash may need to be seen. Reason: to confirm the diagnosis. Exception: close contact with HFMD within the last 7 days.
Treatment is the same. Drink enough fluids to prevent dehydration.
Peeling of the fingers and toes is common. It looks bad but is harmless. It happens at 1 to 2 weeks. Use a moisturizing cream on the raw skin.
Some fingernails and toenails may fall off. It occurs in 4% of severe cases. It happens at 3 to 6 weeks out. Trim them if they catch on things.
Fingernails grow back by 3 to 6 months and toenails by 9 to 12 months. They will look normal.
When To Call
Go to ER Now
Stiff neck, severe headache or acts confused
Weakness in the arms or legs, such as trouble walking
Call Doctor or Seek Care Now
Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Red, swollen and tender gums
Ulcers and sores also on the outer lip
Rash spreads to the arms and legs (severe form of HFMD)
Fever lasts more than 3 days
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Fingernails or toenails fall off
You have other questions or concerns
Self Care at Home
Hand-foot-mouth disease and no other problems
Care Advice
What You Should Know About HFM Disease:
Most often, hand-foot-and-mouth disease (HFMD) is a harmless rash.
It is caused by a virus called Coxsackie.
Here is some care advice that should help.
Liquid Antacid for Mouth Pain (Age 1 Year and Older):
For mouth pain, use a liquid antacid (such as Mylanta or the store brand). Give 4 times per day as needed. After meals often is a good time.
Age 1 to 6 years. Put a few drops in the mouth. Can also put it on the mouth sores with a cotton swab.
Age over 6 years. Use 1 teaspoon (5 mL) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
Caution: Do not use regular mouth washes, because they sting.
Fluids and Soft Diet:
Try to get your child to drink adequate fluids.
Goal: Keep your child well hydrated.
Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
Solid Foods. Offer a soft diet. Good ones are mac and cheese, mashed potatoes, cereals with milk and ice cream. Also, avoid foods that need much chewing. Do not give citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
Pain Medicine:
Mouth sores are painful.
Blisters also may be painful, especially on the feet.
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Fever Medicine:
For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Note: Fevers less than 102° F (39° C) are important for fighting infections.
For all fevers: Keep your child well hydrated. Give lots of cold fluids.
Blisters on the Skin
Blisters don't need any special treatment. You can wash them like normal skin.
Blisters on the palms and soles do not open.
Those on arms and elsewhere sometimes open. The fluid is contagious to other people. Open blisters do not need to be covered. They quickly dry over.
Return to School:
HFMD is easily spread to others.
However, most often, it's a mild and harmless illness.
After contact with HFMD, children come down with symptoms in 3-6 days.
Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.
Children with widespread blisters may need to stay home until the blisters dry up. That takes about 7 days.
What to Expect:
Fever lasts 2 or 3 days.
Mouth sores should go away by 7 days.
Rash on the hands and feet lasts 10 days. The rash on the hands and feet may then peel.
Call Your Doctor If:
Signs of dehydration occur
Fever lasts more than 3 days
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A scalp infection with tiny gray bugs called lice
Lice lay many white eggs (nits) in the hair
Symptoms of Head Lice
The eggs are easier to see than the lice. Nits (eggs) are tiny white specks attached to hairs. Unlike dandruff or sand, nits can't be shaken off the hair shafts.
Itching of the scalp is the main symptom.
A scalp rash may be present. The back of the neck is the favorite area.
Cause
Lice are 1/16-inch (2 mm) long gray-colored bugs. They move quickly and are difficult to see.
They are the size of a sesame seed.
The lice feed on blood from the scalp. While the bug is sucking blood, some of its secretions get mixed in. Any scalp rash or bumps is the body's reaction to the bug's saliva.
Lifespan of Lice
The nits (eggs) hatch into lice in about 1 week.
Nits (eggs) that are over ½ inch (1 cm) from the scalp are empty egg cases. They are very white in color.
Off the scalp, nits (eggs) can't survive over 2 weeks.
Adult lice survive 3 weeks on the scalp or 24 hours off the scalp.
Transmission of Head Lice: Live Lice, Not Nits
Only live lice can give lice to another child.
Nits (lice eggs) cannot pass on lice. Nits are attached to the child's hair.
Almost all spread of lice is from direct hair-to-hair contact. Lice cannot jump or fly to another person's hair.
The spread of lice from hats, hair brushes or combs is not common. Headphones and other objects also do not usually spread lice.
Most often, the spread of lice to others occurs at home, not school. Sleepovers and bed-sharing are a major source.
When To Call
Call Doctor Within 24 Hours
Age less than 2 months old
Scalp looks infected (such as pus, soft scabs, open sores)
Call Doctor During Office Hours
You think your child needs to be seen
Not sure your child has head lice
New head lice or nits are seen after treatment
Scalp rash or itch lasts more than 7 days after treatment
You have other questions or concerns
Self Care at Home
Head lice
Care Advice
What You Should Know About Head Lice:
Head lice can be treated at home.
With careful treatment, all lice and nits (lice eggs) are usually killed.
There are no lasting problems from having head lice.
They do not carry any diseases.
They do not make your child feel sick.
Here is some care advice that should help.
Anti-Lice Shampoo:
Buy some anti-lice creme rinse (such as Nix) and follow package directions. No prescription is needed.
First, wash the hair with a regular shampoo. Then, towel dry it before using the anti-lice creme. Do not use a conditioner or creme rinse after shampooing. Reason: It will interfere with Nix.
Pour 2 ounces (full bottle or 60 mL) of Nix into damp hair. People with long hair may need to use 2 bottles.
Work the creme into all the hair down to the roots.
If needed, add a little warm water to work up a lather.
Nix is safe above 2 months old.
Leave the shampoo on for a full 10 minutes. If you don't, it won't kill all the lice. Then rinse the hair well with water and dry it with a towel.
Repeat the anti-lice shampoo in 9 days. Be sure to do this or the lice may come back. Two treatments are always needed. The second treatment will kill any new lice that have hatched from eggs.
Remove the Dead Nits:
Nit removal is not necessary. It should not interfere with the return to school.
Some schools, however, have a no-nit policy. They will not allow children to return if nits are seen. The American Academy of Pediatrics advise that no-nit policies be no longer used. The National Association of School Nurses also takes this stand. If your child's school has a no-nit policy, call your child's doctor.
Reasoning: Only live lice can spread lice to another child. One treatment with Nix kills all the lice.
Nits (lice eggs) do not spread lice. Most treated nits (lice eggs) are dead after the first treatment with Nix. The others will be killed with the 2nd treatment.
Removing the dead nits is not essential or urgent. However, it prevents others from thinking your child still has untreated lice.
Nits can be removed by backcombing with a special nit comb.
You can also pull them out one at a time. This will take a lot of time.
Wetting the hair with water makes removal easier. Avoid any products that claim they loosen the nits. (Reason: Can interfere with Nix)
Hairwashing Precautions to Help Nix Work:
Don't wash the hair with shampoo until 2 days after Nix treatment.
Avoid hair conditioners before treatment. Do not use them for 2 weeks after treatment. Reason: Coats the hair and interferes with Nix.
Treating Close Contacts:
Check the heads of everyone else living in your home. If lice or nits are seen, they also should be treated. Use the anti-lice shampoo on them as well.
Also, anyone with an itchy scalp rash should be treated.
Bedmates of children with lice should also be treated. If in doubt, have your child checked for lice.
Return to School:
Lice are spread by close contact. They cannot jump or fly.
Your child can return to school after 1 treatment with the anti-lice shampoo.
A child with nits doesn't need to miss any school or child care. Nits do not spread to others, nor
do they cause lice in others.
Remind your child not to share combs and hats.
Be sure to tell the school nurse or child care center director. She can check other students in your child's class.
Cleaning the House - Preventing Spread:
Avoid close contact with others until after the first anti-lice treatment.
Lice that are off the body rarely cause infection. Reason: Lice can't live for over 24 hours off the human body. Vacuum your child's room.
Soak hair brushes for 1 hour in a solution containing some anti-lice shampoo.
Wash your child's sheets, blankets, and pillow cases. Wash any clothes worn in the past 2 days. Wash in hot water (130° F or 54° C). This kills lice and nits.
Items that can't be washed (hats, coats, or scarves) should be set aside. Put them in sealed plastic bags for 2 weeks. This is the longest period that nits can survive. (Note: This is an option. This step probably is not needed.)
What to Expect:
With 2 treatments, all lice and nits should be killed.
If lice come back, it can mean another contact with an infected person. It can also be that the shampoo wasn't left on for 10 minutes. It may also mean that hair conditioner was used.
Also, make sure the Nix is repeated in 9 days. If you don't, the lice may come back.
Call Your Doctor If:
New lice or nits are seen in the hair
Scalp rash or itch lasts more than 1 week after the anti-lice shampoo
Sores on scalp start to spread or look infected
You think your child needs to be seen
Your child becomes worse
Extra Care Advice - Cetaphil Cleanser for Nix Treatment Failures:
Go to your drugstore and buy Cetaphil cleanser in the soap department. No prescription is needed. It works by coating the lice and suffocating them.
Apply the Cetaphil cleanser throughout the scalp to dry hair.
After all the hair is wet, wait 2 minutes for Cetaphil to soak in.
Comb out as much excess cleanser as possible.
Blow dry your child's hair. It has to be thoroughly dry down to the scalp to suffocate the lice. Expect this to take 3 times longer than normal drying.
The dried Cetaphil will smother the lice. Leave it on your child's hair for at least 8 hours.
In the morning, wash off the Cetaphil with a regular shampoo.
To cure your child of lice, repeat this process twice in 1 and 2 weeks.
The cure rate can be 97%.
Detailed instructions can be found online: Nuvo Method for Head Lice.
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A fine pink rash caused by overheating
Mainly on the neck, chest, and upper back
Symptoms of Heat Rash
Tiny, pink bumps
Mainly on the neck, chest and upper back
Occurs during hot, humid weather or after lots of sun
Heat rash can be itchy
Older children may have a "prickly" pins and needles feeling
In babies, the rash can have some tiny water blisters
No fever or illness
Also called "prickly heat"
Causes of Heat Rash
Heat rash is caused by blocked-off sweat glands.
Hot Weather. Hot, humid weather can cause the sweat glands to be overworked.
Ointment. Babies can also get it in the wintertime from ointments put on the skin. Reason: Ointments can block off sweat glands.
Location. Heat rash of the forehead can be caused by oil or ointment on the hair. Heat rash of the face of a breastfed baby can be caused by lanolin put on the nipples. Heat rash of the chest can be caused by menthol ointments put on for coughs.
Exercise. Older children can get heat rash with hard exercise.
When To Call
Call Doctor or Seek Care Now
Fever and looks infected (spreading redness or pus)
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Looks infected (spreading redness, pus), but no fever
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Rash is not gone after 3 days of treatment
You have other questions or concerns
Self Care at Home
Heat rash
Care Advice
What You Should Know About Heat Rash:
Heat rash is caused by blocked-off sweat glands.
It's common in hot, humid weather.
Here is some care advice that should help.
Cooling the Skin:
Cool off the skin to treat and prevent heat rash.
For large rashes, give your child a cool bath without soap. Do this for 10 minutes. (Caution: Avoid any chill.) Let the skin air-dry. Do this 3 or more times a day.
For small rashes, put a cool, wet washcloth on the area. Do this for 5 to 10 minutes. Then let the skin air-dry.
Dress in as few layers of clothing as you can.
Lower the temperature in your home if you can.
Sleeping Cooler:
When your child is asleep, run a fan in the bedroom.
During sleep, have your child lie on a cotton towel to absorb sweat. (Note: Only for older children age over 1 year.)
Steroid Cream for Itching:
Use 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
Put it on itchy spots 3 times per day.
Avoid hydrocortisone ointment.
Calamine lotion can also work.
Do Not Use Ointments:
Avoid all ointments or oils on the skin. Reason: They can block off sweat glands.
Be sure the rash isn't caused by a menthol ointment being used for a cough.
What to Expect:
With treatment, heat rash will clear up in 2 to 3 days.
Call Your Doctor If:
Rash lasts more than 3 days on this treatment
Rash starts to look infected
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
An itchy rash made up of raised pink bumps
Most often, rash is very itchy
Symptoms of Hives
Raised pink bumps with pale centers (welts)
Hives look like mosquito bites
Sizes of hives vary from ½ inch (12 mm) to several inches (cm) across
Shapes and location of hives can be different. They can also change often.
Itchy rash
Causes of Widespread Hives
Viral Infection. The most common cause of hives all over the body is viral infections. Research has confirmed this. Other symptoms such as a fever, cough or diarrhea are also present. The hives may last 3 days. This is not an allergy.
Bacterial Infection. Some bacterial infections can also cause hives. A common example is Strep. Hives are also seen with bladder infections. (UTIs)
Drug Reaction. An example is a penicillin rash. Most rashes that start while taking an antibiotic are viral rashes. Allergy tests are normal 90% of the time. Only 10% turn out to be a drug allergy.
Food Reaction. May be an allergy or a coincidence. If the food is a high risk one (such as peanuts), consult an allergist. Hives from foods usually resolve in 6 hours. Hives from infections last for days. Only 3% of hives are due to a food.
Bee Sting. Widespread hives after a sting may be part of a serious allergic reaction. Need to consult an allergist.
Anaphylactic Reaction (Very Serious). The sudden onset of hives with trouble breathing or swallowing. This is a severe allergic reaction to an allergic food or drug. Most often begins within 30 minutes of swallowing the substance. Always within 2 hours of exposure.
Unknown. Over 30% of the time, the cause of hives is not found.
Causes of Localized Hives
Irritants. Hives just in one spot are usually due to skin contact with an irritant. They are not an allergy.
Plants. Many plants cause skin reactions. Sap from evergreens can cause local hives.
Pollen. Playing in the grass can cause hives on exposed skin.
Pet Saliva. Some people get hives where a dog or cat has licked them.
Food. Some children get hives if a food is rubbed on the skin. An example could be a fresh fruit. Some babies get hives around their mouth from drooling a new food.
Insect Bite. Local hives are a reaction to the insect's saliva. Can be very large without being an allergy.
Bee Sting. This is a reaction to the bee's venom. Can be very large without being an allergy.
Localized hives are not caused by drugs, infections or swallowed foods. These get into the bloodstream and cause widespread hives.
When To Call
Call 911 Now
Hives and life-threatening allergic reaction to similar substance in the past and exposure less than 2 hours ago
Trouble breathing or wheezing
Hoarse voice or cough start all of a sudden
Trouble swallowing, drooling or slurred speech start all of a sudden
You think your child has a life-threatening emergency
Go to ER Now
Hives start within 2 hours after a bee sting
Call Doctor or Seek Care Now
Hives start after eating a high-risk food. High-risk foods include nuts, fish, shellfish, or eggs.
Hives started after taking a prescription medicine
Age less than 1 year with hives all over
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Hives started after taking an over-the-counter medicine
Severe hives (such as eyes swollen shut or very itchy)
Fever or joint swelling is present
Stomach pain or vomiting
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Hives make it hard to go to school or do other normal activities. Note: taking Benadryl for 24 hours has not helped.
Food could be the cause
Had hives 3 or more times in past year with no known cause
Hives last more than 1 week
You have other questions or concerns
Self Care at Home
Hives with no other problems
Care Advice
Hives Only on One Part of the Body - What You Should Know:
Most are caused by skin contact with an irritant. Examples are plants, pollen, food or pet
saliva.
Localized hives are not caused by drugs, infections or swallowed foods. They are also not an allergy.
Wash the allergic substance off the skin with soap and water.
If itchy, use a cold pack for 20 minutes. You can also rub the hives with an ice cube for 10 minutes.
Hives just on one part of the body should go away on their own. They don't need Benadryl.
They should go away in a few hours.
Hives All Over the Body - What You Should Know:
Over 10% of children get hives 1 or more times.
Most widespread hives are caused by a viral infection. This is not due to an allergy. Less than 10% are an allergic reaction to a food, drug, or insect bite. Often, the cause is not found.
Here is some care advice that should help.
Benadryl for Hives All Over the Body:
Give Benadryl 4 times per day for hives all over that itch. No prescription is needed.
If you only have another allergy medicine at home (but not Benadryl), use that.
Continue the Benadryl 4 times per day until the hives are gone for 12 hours.
Caution: Do not use if age is under 1 year. Reason: Benadryl is a sedative. Give your doctor a call for advice.
Hives Caused by Foods:
Foods can cause widespread hives.
Sometimes, the hives are just around the mouth.
Hives from foods usually last just a short time. They often are gone in less than 6 hours.
Cool Bath for Itching:
To help with the itching, give a cool bath. Do this for 10 minutes. Caution: Avoid causing a chill.
Can also rub very itchy spots with an ice cube for 10 minutes.
Wash Allergens Off Body:
Give a bath or shower if caused by pollens or animal contact.
Change clothes.
Stay Away from Allergens:
If you know what is causing the hives, avoid this substance. An example is certain foods.
Help your child stay away from this allergen in the future.
Return to School:
Hives cannot be spread to others.
Your child can go back to school once feeling better. The hives shouldn't keep him from normal activities.
For hives from an infection, can go back after the fever is gone. Your child should feel well enough to join in normal activities.
What to Expect:
Hives all over from a viral illness normally come and go.
They may last for 3 or 4 days. Then, they go away.
Most children get hives once.
Call Your Doctor If:
Severe hives not better after 2 doses of Benadryl
Itch not better after 24 hours on Benadryl
Hives last more than 1 week
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Bite from a pet, wild animal or human
Types of Wounds
Bruise. There is no break in the skin. No risk of infection.
Scrape (Abrasion) or Scratch. A wound that doesn't go all the way through the skin. Low chance of infection. Antibiotic drugs are not needed.
Cut (Laceration). A wound that goes through the skin to the fat or muscle tissue. Some chance of infection. Most need to be seen. Cleaning the wound can help prevent this. Antibiotic drugs may be needed.
Puncture Wound. These wounds break through the skin. Greater risk of infection. Puncture wounds from cat bites are more likely to get infected. Antibiotic drugs may be needed.
Wound Infection. This is the main risk of an animal bite. The main finding is redness around the bite and pain. It starts 8 hours to 3 days after the bite. It can often be prevented by early, careful cleaning of the bite. This is why most animal bites need to be seen.
Types of Animal Bites
Large Wild Animal Bites. Rabies is a disease that can kill people. Bites or scratches from any large wild animal can pass on rabies. Animals at highest risk are bats, skunks, raccoons, foxes, or coyotes. These animals may spread rabies even if they have no symptoms.
Small Wild Animal Bites. Small animals such as mice, rats, moles, or gophers do not carry rabies. Chipmunks, prairie dogs, squirrels and rabbits also do not carry rabies. Exception: one of these small animals actually attacks a human (an unprovoked bite). Sometimes, their bites can get infected.
Large Pet Animal Bites. Most bites from pets are from dogs or cats. Bites from other pets such as horses can be handled using this guide. Dogs and cats are free of rabies in most U.S. and Canadian cities. Stray animals are always at risk for rabies until proven otherwise. Cats and dogs that always stay indoors should be safe. The main risk in pet bites is wound infection, not rabies. Cat bites become infected more often than dog bites. Cat scratches can get infected just like a bite because cats lick their claws.
Small Indoor Pet Animal Bites. Small indoor pets are not at risk for rabies. Examples of these pets are gerbils, hamsters, guinea pigs, or mice. Tiny puncture wounds from these small animals also don't need to be seen. They carry a small risk for wound infections.
Human Bites. Most human bites occur during fights, especially in teenagers. Sometimes a fist is cut when it strikes a tooth. Human bites are more likely to become infected than animal bites. Bites on the hands are at higher risk. Many toddler bites are safe because they don't break the skin.
Bat Bites and Rabies. In the U.S., 90% of cases of rabies in humans are caused by bats. Bats have spread rabies without a visible bite mark.
Animals at Risk for Rabies
Bat, skunk, raccoon, fox, or coyote
Other large wild animals
Pets that have never had rabies shots and spend time outdoors
In the U.S., rabies occurs 4 times more in cats than in dogs.
Outdoor animals who are sick or stray
Dogs or cats in countries that do not require rabies shots
In the U.S. and Canada, bites from city dogs and cats are safe.
In the U.S., there are 2 - 3 deaths from rabies per year in humans.
When To Call
Call 911 Now
Major bleeding that can't be stopped
Not moving or too weak to stand
You think your child has a life-threatening emergency
Go to ER Now
Bleeding that won't stop after 10 minutes of direct pressure
Any scratch or cut from an animal at risk for Rabies
Call Doctor or Seek Care Now
Wild animal bite that breaks the skin
Pet animal (such as dog or cat) bite that breaks the skin. Exception: minor scratches that don't go through the skin.
Puncture wound (holes through skin) from a Cat's teeth or claws
Puncture wound (holes through skin) of hand or face
Human bite that breaks the skin
Bite looks infected (redness or red streaks) or has a fever
Bat contact or exposure, even without a bite mark
Contact with a rabies-prone animal, even without a bite mark
Minor cut or scrape and no past tetanus shots
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Last tetanus shot more than 5 years ago
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Bite did not break the skin or is only a bruise
Minor scratches that don't go through the skin from a pet
Tiny puncture wound from small pet, such as a hamster or puppy. Exception: cat puncture wound.
Care Advice
What You Should Know About Bites:
Bites that don't break the skin can't become infected.
Cuts and punctures always are at risk for infection.
Here is some care advice that should help.
Clean the Bite:
Wash all wounds right now with soap and water for 5 minutes.
Also, flush well under running water for a few minutes. Reason: Can prevent many wound infections.
Bleeding - How to Stop:
For any bleeding, put pressure on the wound.
Use a gauze pad or clean cloth.
Press for 10 minutes or until the bleeding has stopped.
Antibiotic Ointment:
For small cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed.
Put it on the cut 3 times a day.
Do this for 3 days.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Cold Pack for Pain:
For pain or bruising, use a cold pack. You can also use ice wrapped in a wet cloth. Apply it to the bruise once for 20 minutes. Reason: Helps with bleeding, pain and swelling.
What to Expect:
Most scratches, scrapes and other minor bites heal up fine in 5 to 7 days.
Call Your Doctor If:
Bite starts to look infected (pus, redness, red streaks)
Fever occurs
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Reactions to a recent immunization (vaccine)
Most are reactions at the shot site (such as pain, swelling, redness)
General reactions (such as a fever or being fussy) may also occur
Reactions to These Vaccines are Covered:
Chickenpox (varicella) virus
DTaP (Diphtheria, Tetanus, Pertussis)
Hemophilus influenzae type b
Hepatitis A virus
Hepatitis B virus
Human Papilloma virus
Influenza virus
MMR (Measles, Mumps, Rubella)
Meningococcal
Polio virus
Pneumococcal
Rotavirus
Tuberculosis (BCG vaccine)
Symptoms of Vaccine Reactions
Local Reactions. Shot sites can have swelling, redness and pain. Most often, these symptoms start within 24 hours of the shot. They most often last 3 to 5 days. With the DTaP vaccine, they can last up to 7 days.
Fever. Fever with most vaccines begins within 24 hours and lasts 1 to 2 days.
Delayed Reactions. With the MMR and chickenpox shots, fever and rash can occur. These symptoms start later. They usually begin between 1 and 4 weeks.
Anaphylaxis. Severe allergic reactions are very rare, but can occur with any vaccine. They start within 2 hours.
Vaccine Free App
Vaccines on the Go app from Children's Hospital of Philadelphia
This free app can answer any vaccine questions you may have
It is fact-based and up-to-date
When To Call
Call 911 Now
Trouble breathing or swallowing
Not moving or very weak
Can't wake up
You think your child has a life-threatening emergency
Go to ER Now
Hard to wake up
Call Doctor or Seek Care Now
Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.
Fever over 104° F (40° C)
High-pitched crying lasts more than 1 hour
Crying nonstop lasts more than 3 hours
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Redness or red streak starts more than 48 hours (2 days) after the shot
Redness around the shot becomes larger than 3 inches (7.5 cm)
Fever lasts more than 3 days
Fever returns after being gone more than 24 hours
Measles vaccine rash (starts day 6 to 12 after shot) lasts more than 4 days
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Redness or red streak around shot is larger than 1 inch (2.5 cm)
Redness, swelling or pain is getting worse after 3 days
Fussiness from vaccine lasts more than 3 days
You have other questions or concerns
Self Care at Home
Normal immunization reaction
Care Advice
Treatment for Common Immunization Reactions
What You Should Know About Common Shot Reactions:
Immunizations (vaccines) protect your child against serious diseases.
Pain, redness and swelling are normal where the shot was given. Most symptoms start within the first 12 hours after the shot was given. Redness and fever starting on day 1 of the shot is always normal.
All of these reactions mean the vaccine is working.
Your child's body is making new antibodies to protect against the real disease.
Most of these symptoms will only last 2 or 3 days.
There is no need to see your doctor for normal reactions, such as redness or fever.
Medicine is only needed if your child has pain. Also, use a fever medicine for fever over 102° F (39 ° C).
Here is some care advice that should help.
Reaction at Shot Site:
Cold Pack: For pain at the shot site, use a cold pack. You can also use put ice in a wet washcloth on the sore shot site. Use for 20 minutes as needed.
Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed.
Hives at the Shot Site: If itchy, can put on 1% hydrocortisone cream (such as Cortaid). No prescription is needed. Use twice daily as needed.
Fever Medicine:
Fever with most vaccines begins within 12 hours and lasts 2 to 3 days. This is normal, harmless and possibly helpful.
For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
If over 6 months old, can give an ibuprofen product (such as Advil).
For all fevers: Give extra fluids. Do not use too many clothes or blankets on your child.
General Symptoms From Vaccines:
All vaccines can cause mild fussiness, crying and restless sleep. This is usually due to a sore shot site.
Some children sleep more than usual. A decreased appetite and activity level are also common.
These symptoms are normal. They do not need any treatment.
They will usually go away in 24-48 hours.
Call Your Doctor If:
Redness starts after 2 days (48 hours)
Redness becomes larger than 2 inches (5 cm)
Pain or redness gets worse after 3 days (or lasts more than 7 days)
Fever starts after 2 days (or lasts more than 3 days)
You think your child needs to be seen
Your child becomes worse
Specific Immunization Reactions
Chickenpox Vaccine:
Pain or swelling at the shot site for 1 to 2 days. (20% of children)
Mild fever lasting 1 to 3 days begins 14 to 28 days after the shot (10%). Give acetaminophen or ibuprofen for fever over 102° F (39°C).
Never give aspirin for fever, pain or within 6 weeks of getting the shot. Reason: Risk of Reye syndrome, a rare but serious brain disease.
Chickenpox-like rash (usually 2 red bumps) at the shot site (3%)
Chickenpox-like rash (usually 5 red bumps) scattered over the body (4%)
This mild rash begins 5 to 26 days after the shot. Most often, it lasts a few days.
Children with these rashes can go to child care or school. Reason: For practical purposes, vaccine rashes are not spread to others.
Exception: Do not go to school if red bumps drain fluid and are widespread. Reason: can be actual chickenpox.
Caution: If vaccine rash contains fluid, cover it with clothing. You can also use a bandage (such as Band-Aid).
Diphtheria, Tetanus, Pertussis (DTaP) Vaccine:
The following harmless reactions to DTaP can occur:
Pain, tenderness, swelling and redness at the shot site are the main side effects. This happens in 25% of children. It usually starts within the first 12 hours. Redness and fever starting on day 1 of the shot is always normal. It lasts for 3 to 7 days.
Fever (in 25% of children) and lasts for 24 to 48 hours
Mild drowsiness (30%), fretfulness (30%) or poor appetite (10%) and lasts for 24 to 48 hours.
Large swelling over 4 inches (10 cm) can follow the later doses of DTaP. The area of redness is smaller. This usually occurs with the 4th or 5th dose. It occurs in 5% of children. Most children can still move the leg or arm normally.
The large thigh or upper arm swelling goes away without treatment by day 3 (60%) to day 7 (90%).
This is not an allergy. Future DTaP vaccines are safe to give.
Hemophilus Influenza Type B Vaccine (Hib):
No serious reactions reported.
Sore injection site or mild fever only occurs in 2% of children.
Hepatitis A Vaccine:
No serious reactions reported.
Sore injection occurs in 20% of children.
Loss of appetite occurs in 10% of children.
Headache occurs in 5% of children.
Most often, no fever is present.
If these symptoms occur, they most often last 1-2 days.
Hepatitis B Virus Vaccine (HBV):
No serious reactions reported.
Sore shot site occurs in 30% of children and mild fever in 3% of children.
Fever from the vaccine is rare. Any baby under 2 months with a fever after this shot should be examined.
Influenza Virus Vaccine:
Pain, tenderness or swelling at the injection site occurs within 6 to 8 hours. This happens in 10% of children.
Mild fever under 103° F (39.5° C) occurs in 20% of children. Fevers mainly occur in young children.
Nasal Influenza Vaccine: Congested or runny nose, mild fever.
Measles Vaccine (part of MMR):
The measles shot can cause a fever (10% of children) and rash (5% of children). This occurs about 6 to 12 days after the shot.
Mild fever under 103° F (39.5°C) in 10% and lasts 2 or 3 days.
The mild pink rash is mainly on the trunk and lasts 2 or 3 days.
No treatment is needed. The rash cannot be spread to others. Your child can go to child care or to school with the rash.
Call Your Doctor If:
Rash changes to blood-colored spots
Rash lasts more than 3 days
Meningococcal Vaccine:
No serious reactions.
Sore shot site for 1 to 2 days occurs in 50%. Limited use of the arm occurs in 15% of children.
Mild fever occurs in 5%, headache in 40% and joint pain in 20%
The vaccine never causes meningitis.
Mumps or Rubella Vaccine (part of MMR):
There are no serious reactions.
Sometimes, a sore shot site can occur.
Papillomavirus Vaccine:
No serious reactions.
Sore injection site for few days in 90%.
Mild redness and swelling at the shot site (in 50%).
Fever over 100.4° F (38.0° C) in 10% and fever over 102° F (39° C) in 2%.
Headache in 30%.
Pneumococcal Vaccine:
No serious reactions.
Pain, tenderness, swelling or redness at the injection site in 20%.
Mild fever under 102° F (39° C) in 15% for 1-2 days.
Polio Vaccine:
Polio vaccine given by shot sometimes causes some muscle soreness.
Polio vaccine given by mouth is no longer used in the U.S.
Rotavirus Vaccine:
No serious reactions to this vaccine given by mouth.
Mild diarrhea or vomiting for 1 to 2 days in 3%.
No fever.
BCG Vaccine for Tuberculosis (TB):
Vaccine used to prevent TB in high-risk groups or countries. It is not used in the US or most of Canada. Note: This is different than the skin test placed on the forearm to detect TB.
BCG vaccine is given into the skin of the right shoulder area.
Timing: Mainly given to infants and young children.
Normal reaction: After 6 to 8 weeks, a blister forms. It gradually enlarges and eventually drains a whitish yellow liquid. The blister then heals over leaving a scar. The raised scar is proof of BCG protection against TB.
Abnormal reaction: Abscess (infected lump) occurs in the shoulder or under the arm. Occurs in 1% of patients.
Call Your Doctor If:
Blister turns into a large red lump
Lymph node in the armpit becomes large
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Coin-shaped sores on the skin covered by scabs
The infected crusts are the color of honey
Skin infection caused by a bacteria
Symptoms of Impetigo
Sores smaller than 1 inch (2.5 cm)
Often covered by a soft, yellow-brown scab or crust
Scabs may drain pus or yellow fluid off and on
Starts as small red bumps. These change quickly to cloudy blisters or pimples. Then, they become open sores which drain fluid or pus.
Sores increase in size
Any sore or wound that grows and doesn't heal is usually impetigo.
Cause of Impetigo
A skin infection caused by a bacteria. It starts in a small break in the skin. Examples are a scratch or insect bite.
The most common bacteria are Staph and Strep. If the child has a sore throat, they may also have Strep throat. A rapid Strep test will give the answer.
Impetigo often spreads and increases in number from scratching.
When To Call
Call Doctor or Seek Care Now
Pink or tea-colored urine
Fever and spreading redness around the impetigo
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Spreading redness around the impetigo and no fever
Fever or sore throat are present
Sore is larger than 1 inch (2.5 cm) across
Sores and crusts inside the nose
Impetigo gets worse after 48 hours on antibiotic ointment
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Impetigo in 2 or more children (such as siblings or play groups)
Child plays contact sports. Reason: to prevent spread.
3 or more impetigo sores. Reason: may need an oral antibiotic. Many of these children also have a Strep throat.
Not healed up after 1 week on antibiotic ointment
You have other questions or concerns
Self Care at Home
Mild impetigo (1 or 2 sores that started with a scratch or insect bite)
Care Advice
What You Should Know About Impetigo:
Impetigo is a skin infection. Most often, it starts in a scratch or insect bite.
It usually responds to treatment with any antibiotic ointment.
Here is some care advice that should help.
Remove Scabs:
Soak off the scab using soap and warm water. The bacteria live underneath the scab.
Antibiotic Ointment:
Put an antibiotic ointment (such as Polysporin) on the sores. No prescription is needed. You can also use one you already have.
Do this 3 times per day.
Cover it with a bandage (such as Band-Aid) to prevent scratching and spread.
Repeat the washing, ointment and dressing 3 times per day.
Do Not Pick at the Sores:
Help your child not to scratch and pick at the sores. This spreads the impetigo.
Return to School:
Impetigo is spread to others by contact with skin lesions.
Wash the hands often. Try not to touch the sores.
For mild impetigo (1 or 2 sores), can go to school if it is covered.
For severe impetigo, child needs to take an oral antibiotic for more than 24 hours. Then your child can go back to school.
Contact Sports. In general, needs to be on antibiotics for 3 days before returning to sports. There must be no pus or drainage. Check with the team's trainer if there is one.
What to Expect:
Sore stops growing in 1 to 2 days.
The skin is healed in 1 week.
Call Your Doctor If:
Impetigo sore gets bigger after 48 hours on antibiotic ointment
Gets new impetigo sore on antibiotic ointment
Not healed up in 1 week
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Bite from an insect (bug)
Bees, mosquitoes, fire ants, ticks and spiders are not covered. See those care guides.
Symptoms of Insect Bites
Insect bites usually cause a small red bump.
Often, it looks like localized hives (one large one or several small ones).
Sometimes, a small water blister occurs in the center of the bump. This is common in younger children.
Itchy Insect Bites. Bites of mosquitoes, chiggers (harvest mites), fleas, and bedbugs usually cause itchy, red bumps.
Painful Insect Bites. Bites of horseflies, deer flies, and gnats usually cause a painful, red bump. Fire ants, harvester ants, blister beetles, and centipedes also cause a painful, red bump. Within a few hours, fire ant bites can change to blisters or pimples.
Cause of Insect Bite Reaction
The skin bumps are the body's reaction to the insect's saliva.
While the bug is sucking blood, some of its secretions get mixed in.
Anaphylaxis With Insect Bites: Very Rare
A severe life-threatening allergic reaction is called anaphylaxis.
The main symptoms are difficulty breathing and swallowing starting within 2 hours of the sting. Onset usually is within 20 minutes.
Anaphylaxis can occur with bee, yellow jacket, wasp, or fire ant stings. Anaphylactic reactions are very rare after other insect bites. Reason: other insects don't have venom.
Problems Caused by Insect Bites
Impetigo. A local bacterial infection. Gives sores, soft scabs and pus. Caused by scratching or picking at the bites. More common in itchy bites.
Cellulitis. The bacterial infection spreads into the skin. Gives redness spreading out from the bite. The red area is painful to the touch.
Lymphangitis. This is a bacterial infection that spreads up the lymph channels. Gives a red line that goes up the arm or leg. More serious because the infection can get into the bloodstream. (This is called sepsis.)
When To Call
Call 911 Now
Past life-threatening allergic reaction to same insect bite (not just hives) and bitten less than 2 hours ago
Trouble breathing or wheezing
Hoarse voice, cough, or tightness in the throat or chest
Trouble swallowing, drooling or slurred speech
Hard to wake up
Acts or talks confused
You think your child has a life-threatening emergency
Go to ER Now
Stiff neck (can't touch chin to the chest)
Call Doctor or Seek Care Now
Hives or swelling all over the body
More than 20 fire ant stings in a child less than 1 year old
Fever and bite looks infected (spreading redness)
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Severe pain and not better 2 hours after taking pain medicine
New redness around the bite starts more than 24 hours after the bite
More than 48 hours since the bite and redness gets larger
Redness or red streak around the bite gets larger than 1 inch (2.5 cm)
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Scab that looks infected (drains pus or gets bigger) not better with antibiotic ointment
You have other questions or concerns
Self Care at Home
Normal insect bite
Questions about insect repellents (such as DEET)
Care Advice
Treatment for Insect Bites
What You Should Know About Insect Bites:
Most insect bites cause a red bump. Some are larger (like a hive). Some have a small water blister in the center. These are normal reactions to an insect bite.
A large hive at the bite does not mean your child has an allergy.
The redness does not mean the bite is infected.
Here is some care advice that should help.
Itchy Insect Bite Treatment:
Steroid Cream. To reduce the itching, use 1% hydrocortisone cream (such as Cortaid). No prescription is needed. Put it on 3 times a day until the itch is gone. If you don't have, use a baking soda paste until you can get some.
If neither is available, use ice in a wet washcloth for 20 minutes.
Also, you can put firm, sharp, direct, steady pressure on the bite. Do this for 10 seconds to reduce the itch. A fingernail, pen cap, or other object can be used.
Allergy Medicine. If the bite is still itchy, try an allergy medicine (such as Benadryl). No prescription is needed. Sometimes it helps, especially in allergic children.
Painful Insect Bite Treatment:
Soak a cotton ball in a baking soda solution. Rub the bite with it for 15 to 20 minutes. Do this once. This will usually reduce the pain.
You can also use an ice cube in a wet washcloth for 20 minutes.
To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed.
For painful bites, allergy medicines don't help.
Antibiotic Ointment for Infected Bite:
If the insect bite has a scab on it and the scab looks infected, use an antibiotic ointment. An example is Polysporin. No prescription is needed. Use 3 times per day. (Note: Usually impetigo is caused by scratching with dirty fingers).
Cover the scab with a bandage (such as Band-Aid). This will help prevent scratching and spread.
Wash the sore and use the antibiotic ointment 3 times per day. Cover it with a clean bandage each time. Do this until healed.
Caution: For spreading infections (redness or red streaks), your child needs to be seen.
What to Expect:
Most insect bites are itchy for several days.
Any pinkness or redness usually lasts 3 days.
The swelling may last 7 days.
Insect bites of the upper face can cause severe swelling around the eye. This is harmless.
The swelling is usually worse in the morning after lying down all night. It will improve after standing for a few hours.
Call Your Doctor If:
Severe pain lasts more than 2 hours after pain medicine
Infected scab not better after 48 hours of antibiotic ointment
Bite looks infected (spreading redness gets bigger after 48 hours)
You think your child needs to be seen
Your child becomes worse
Prevention of Insect Bites
Prevention Tips:
Wear long pants, a long-sleeved shirt and a hat.
Avoid being outside when the bugs are most active. Many insects that cause itchy bites are most active at sunrise or sunset. Examples are chiggers, no-see-ums, and mosquitoes.
Insect repellents that contain DEET are helpful in preventing many insect bites. Read the label carefully.
DEET Products: Use on the Skin.
DEET is a very effective bug repellent. It also repels ticks and other insects.
The AAP approves DEET use over 2 months of age. Use 30% DEET or less. Use 30% DEET if you need 6 hours of protection. Use 10% DEET if you only need protection for 2 hours. (AAP 2003).
Don't put DEET on the hands if your child sucks on their thumb or fingers. (Reason: prevent swallowing DEET.)
Warn older children who apply their own DEET to use less. A total of 3 or 4 drops can protect the whole body.
Put it on exposed areas of skin. Do not use near the eyes or mouth. Do not use on skin that is covered by clothing. Don't put DEET on sunburns or rashes. Reason: DEET can be easily absorbed in these areas.
Wash it off with soap and water when your child comes indoors.
Caution: DEET can damage clothing made of man-made fibers. It can also damage plastics (such as eye glasses) and leather. DEET can be used on cotton clothing.
Permethrin Products: Use on Clothing.
Products that contain permethrin (such as Duranon) work well to repel insects and ticks.
Unlike DEET, these products are put on clothing instead of skin.
Put it on shirt cuffs, pant cuffs, shoes and hats.
You can also use it on other outdoor items (mosquito screens, sleeping bags).
Do not put permethrin on the skin. Reason: Sweat changes it so it does not work.
Picaridin Products:
Picaridin is a repellent that is equal to 10% DEET.
It can safely be put on skin or clothing.
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Jaundice (yellow skin) in a baby during the first months of life
The skin turns a yellow color from high bilirubin levels in the blood
Jaundice and Bilirubin
Jaundice means the skin has turned yellow.
Bilirubin is the pigment that turns the skin yellow.
Bilirubin comes from the normal breakdown of old red blood cells.
The liver normally gets rid of bilirubin. But, at birth, the liver may be immature.
Half of babies have some jaundice. Usually it is mild.
The level of bilirubin that is harmful is around 20. Reaching a level this high is rare.
High levels need to be treated with bili-lights. That's why your doctor checks your baby's bilirubin levels until it becomes low.
Causes of Jaundice in Newborns
Physiological Jaundice (50% of newborns)
Onset 2 to 3 days of age
Peaks day 4 to 5, then improves
Disappears 1 to 2 weeks of age
Breastfeeding or Malnutrition Jaundice (5 to 10% of newborns)
Due to inadequate intake of breastmilk
Pattern similar to physiological type
Also, causes poor weight gain
Breastmilk Jaundice (10% of newborns)
Due to substance in breastmilk which blocks removal of bilirubin
Onset 4 to 7 days of age
Lasts 3 to 12 weeks
Not harmful
Rh and ABO Blood Group Incompatibility (Serious, but Rare)
Onset during first 24 hours of life
Can reach harmful levels
Liver Disease (Serious, but Rare)
The main clue is light gray or pale yellow stools
The jaundice doesn't go away
Causes include liver infection (hepatitis) and liver blockage (biliary atresia)
When To Call
Call 911 Now
Can't wake up
Not moving or very weak
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Age less than 1 month old and looks or acts abnormal in any way
Feeding poorly (such as poor suck, does not finish)
Hard to wake up
Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
Fever. Caution: do NOT give your baby any fever medicine before being seen.
Low temperature below 96.8° F (36.0° C) rectally that does not go up with warming
Jaundice began during the first 24 hours of life
Skin looks deep yellow or orange
Jaundice has reached the legs
Jaundice worse than when last seen
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
High-risk baby for severe jaundice. Risk factors are: premature baby born at 36 weeks or less, ABO or Rh blood group problem, sib needed bili-lights, bleeding in the scalp, Asian race, breastfeeding problems.
Whites of the eyes have turned yellow
Jaundice spreads to stomach (belly)
You are worried about the amount of jaundice
You are worried your baby is not getting enough breastmilk
Yellow, seedy stools are less than 3 per day. Exception: breastfed and before 5 days of life.
Day 2-4 of life and no stool in more than 24 hours and breastfed
Wet diapers are less than 6 per day. Exception: 3 wet diapers per day can be normal before 5 days of life if breastfed.
4 or more days old and has not been checked since discharge
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Color gets deeper yellow after 7 days old
Jaundice is not gone after 14 days of age
Jaundice began or comes back after 7 days of age
Stools are white, pale yellow or gray
You have other questions or concerns
Self Care at Home
Mild jaundice of newborn
Care Advice
What You Should Know About Newborn Jaundice:
Some jaundice is present in 50% of newborns.
It lasts a short time and will go away. Most often, it is harmless.
The first place for jaundice to start is on the face.
Jaundice that is only of the face is always harmless.
Here is some care advice that should help.
Bottle Feed More Often:
If bottle fed, increase how often you feed your baby.
Try to feed every 2 to 3 hours during the day.
Don't let your baby sleep more than 4 hours at night without a feeding.
Breastfeed More Often:
If breastfed, increase how often your feed your baby.
Nurse your baby every 1½ to 2 hours during the day.
Don't let your baby sleep more than 4 hours at night without a feeding.
Goal: At least 10 feedings every 24 hours.
Infrequent Stools Means Your Baby Needs More Milk:
Breastmilk and formula help carry bilirubin out of the body. Therefore, good feedings are important for bringing down the bilirubin level.
In the first month, keep track of how many stools are passed daily. The number of stools reflects how much milk your baby is getting.
If your baby is 5 days or older, he should have at least 3 stools daily. If stooling less than that, it usually means your baby needs more to eat.
Try to increase the number and amount of feedings per day.
If you are having any trouble with breastfeeding, consult a lactation expert. Also, schedule a weight check.
What to Expect:
Physiological jaundice peaks on day 4 or 5.
It slowly goes away over 1-2 weeks.
Judging Jaundice:
Jaundice starts on the face and moves downward. Try to determine where it stops.
View your baby unclothed in natural light near a window.
Press on the skin with a finger to remove the normal skin tone.
Then try to look if the skin is yellow before the pink color returns.
Move down the body, doing the same. Try to look where the yellow color stops.
Jaundice that only involves the face is harmless. As it involves the chest, the level is going up. If it involves the eyes, stomach, arms or legs, the bilirubin level needs to be checked.
Call Your Doctor If:
Jaundice gets worse
Whites of the eyes turn yellow
Belly or legs turn yellow
Feeds poorly or has a weak suck
Baby starts to look or act abnormal
Jaundice lasts more than 14 days
You think your child needs to be seen
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Sting from a jellyfish
Jellyfish cause most of the stings that occur in sea water
The creature's stinger injects venom into the human skin. This is what causes the sting.
The main symptoms are pain, burning and redness at the sting site. Red lines are common.
The Sea Nettle is a type of stinging jellyfish often found in Chesapeake Bay
Jellyfish Facts
They are umbrella shaped, clear sea creatures with long trailing tentacles. They move slowly through the water by pulsing the upper body. Also carried by ocean currents. Their tentacles can be 10 feet or longer.
Other Names. Jellies or sea jellies. Large groups of jellies are called a bloom. Blooms can close beaches.
Where They Live. Found in every ocean and coastline.
Numbers. Jellies have increased in numbers worldwide. Warmer ocean temps and pollution of ocean waters are factors. Fishing the ocean too much is also a cause. Tuna, shark and swordfish eat jellies.
Stings. Stings can occur while wading, swimming or diving in salt water. Honolulu gets over 1000 911 calls per month for stings.
Beached Jellies. Even beached or dying jellies can sting. So can pieces of tentacles floating in the water. They can release venom for up to 2 weeks.
Treatment. Vinegar is used to stop the venom in stingers. Caution: Do not use ammonia, urine, rubbing alcohol, fresh water or ice. They all can trigger the release of more venom. If you don't have vinegar, move on to scraping off the stingers.
Prevention. Mainly do not go in the water where jellies are seen. Wearing a thin layer of clothing (such as pantyhose) also can protect you. Reason: The stingers are short and cannot puncture clothing. Special "stinger suits" can be bought in diving stores.
Cause of Sting Reactions
The long tentacles have thousands of stingers.
When a stinger is touched, it pierces the skin and injects venom.
The venom is what causes all the symptoms.
Types of Jellyfish Sting Reactions
Local Reactions are most common. Symptoms are raised, red lines that cross each other. The sting causes pain or burning at the site. Sometimes hives in the sting area occur. Blisters can occur in severe cases. Severe pain lasts 1-2 hours. Itch may last for a week. If the skin damage is severe, red or purple lines can last for weeks.
General Reactions can occur if there are many stings. More stings give a higher dose of venom. Large venom symptoms are vomiting, dizziness, weakness and headache.
Anaphylaxis (A severe allergic reaction). Life-threatening reactions are very rare with the stings. Most are caused by box jellyfish found in the South Pacific and Australia. The main symptoms are trouble breathing and swallowing, along with hives. It starts rapidly, most often within 20 minutes of the sting.
When To Call
Call 911 Now
Past severe allergic reaction to jellyfish stings (not just hives) and stung less than 2 hours ago
Wheezing or trouble breathing
Hoarseness, cough or tightness in the throat or chest
Trouble swallowing or drooling
Speech is slurred
Acts or talks confused
Passed out (fainted) or too weak to stand
You think your child has a life-threatening emergency
Go to ER Now
Hives or swelling all over the body (but normal breathing)
Muscle cramps or spasms
Call Doctor or Seek Care Now
Sting inside the mouth
Sting on the eye
Sting covers a large area (more than 1 arm or leg)
Stomach pain or vomiting
Fever and sting looks infected (spreading redness)
Severe pain not improved after 2 hours using care advice
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Blisters appear
More than 48 hours since the sting and redness getting larger
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Severe itching not better after 24 hours of using steroid cream
Redness or rash lasts more than 48 hours
Last tetanus shot was more than 10 years ago
You have other questions or concerns
Self Care at Home
Jellyfish sting - Normal local reaction
Care Advice
What You Should Know About Jellyfish Stings:
Jellyfish cause most of the stings that occur in the ocean.
Most stings are harmless. The pain is like a bee sting.
Jellies have long tentacles with lots of tiny stingers.
Pieces of tentacles that wash up on the beach can still cause stings.
They produce lines of redness and burning pain.
Here is some care advice that should help.
Step 1 - Sea Water Rinse to Remove Large Tentacles:
Rinse area with sea water. This will help remove any large tentacles stuck to the skin.
Do not rinse with fresh water (will trigger stingers).
Do not scrub or rub area (will trigger stingers).
Do this until you can get some vinegar.
Step 2 - Vinegar Rinse to Stop the Stinging: (Exception: Chesapeake Bay jellyfish - see #6)
Rinse area with vinegar (5% acetic acid) for 15 minutes.
Reason: Stops the stingers from stinging if still attached to the skin.
Caution: Do not use with Chesapeake Bay jellyfish. (Reason: May trigger stingers. Instead, use a baking soda rinse with these stings).
Avoid rubbing alcohol for all stings. Reason: will trigger the stingers.
If you can't get vinegar, move on to scraping off the stingers.
Step 3 - Scrape the Area to Remove Small Stingers:
Scrape off any stingers you can see. Use the edge of a credit card or dinner knife.
Do not use your bare fingers. (Reason: you will get stings on your hands). Put on gloves if you have them.
Then, coat area with shaving cream or any mild cream. Scrape the area again.
If the stingers are stuck to body hair, shave with a razor.
Step 4 - Repeat Vinegar Rinse: (Exception: Chesapeake Bay Jellyfish - go to #6)
Keep a cloth wet with vinegar on the area.
Do this for 15 more minutes.
Chesapeake Bay Jellyfish (Sea Nettle) - Baking Soda Rinse To Stop The Stinging:
Rinse area with a mixture of sea water and baking soda for 15 minutes.
This stops the stingers from stinging if still attached to the skin.
Then, remove small stingers with scraping or shaving.
Caution: Do not use vinegar rinse.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Cold Pack for Pain:
For pain and swelling, rub with an ice cube. You can also use a cold wet washcloth. Do this for 10 minutes as needed.
Caution: Don't use until stingers are removed. (Reason: water or ice will trigger stingers).
Steroid Cream for Itching:
For itching or swelling, put 1% hydrocortisone cream (such as Cortaid) on the sting.
No prescription is needed.
Use 3 times per day.
Keep the cream in the fridge. (Reason: it feels better if put on cold).
What to Expect:
Minor stings: Severe burning pain will lessen within 1-2 hours. Red blotches and lines often improve in 24 hours. Red lines may last 1-2 weeks.
More severe stings: Blisters appear within 6 hours. You should be seen by a doctor if blisters appear.
Call Your Doctor If:
Blisters appear
Severe pain persists over 2 hours
Redness or rash lasts over 2 weeks
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Rash of the groin and inner, upper thighs caused by a fungus
Much more common in males than females
Symptoms
Pink-red, scaly rash on inner thighs near groin. Often, starts in the groin crease. Then, spreads slowly downward.
In boys, the rash does not involve the penis or scrotum.
Rash is most often the same on both inner thighs.
Rash is itchy, but not painful.
Cause
Jock itch is caused by a fungus. Often, this is the same fungus that causes athlete's foot.
It can come from a towel used to dry the feet and then the groin.
The fungus can only grow in warm, damp skin. Sweating a lot and wearing damp underwear raises the chance of getting it.
Called jock itch because it occurs mostly in teen males who play sports.
How to Prevent Jock Itch From Coming Back
Keep the groin area clean and dry. Reason: the fungus can't grow on dry, normal skin.
Change to dry underwear after playing sports.
Also, avoid wearing underwear that is too tight.
Bring gym clothes home. Wash at least weekly.
If you have athlete's foot, use a separate towel for the feet.
When To Call
Call Doctor or Seek Care Now
Rash is very painful to touch
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor During Office Hours
Female
Age less than 10 years
Rash is mainly on the penis or scrotum
Pus is draining from the rash
Rash keeps spreading after 1 week on treatment
Rash is not gone after 4 weeks on treatment
You think your child needs to be seen, but the problem is not urgent
You have other questions or concerns
Self Care at Home
Jock itch rash
Care Advice
What You Should Know About Jock Itch:
Jock itch is common in teens. It is harmless.
It's caused by a fungus that grows best on warm, damp skin.
Here is some care advice that should help.
Antifungal Cream:
Use an antifungal cream 2 times per day.
Some brand names are Lamisil, Micatin or Lotrimin cream. No prescription is needed.
Put it on the rash and 1 inch beyond its borders. Make sure you put it on in all the creases.
Keep using the cream for at least 7 days after the rash is gone.
Keep Area Dry:
Jock itch will heal faster if the groin area is kept dry.
Wash the rash area once a day with plain water. Dry it with care. Do not use soap on the rash.
Wear loosely fitting cotton underwear. Wash gym shorts and jockstraps after each use.
Try Not to Scratch:
Avoid scratching the area. Reason: Scratching will delay the cure.
What to Expect:
Rash stops spreading after treated for 2-3 days.
With proper treatment, rash goes away in 2-3 weeks.
Return to School:
Children with jock itch do not need to miss any school. Your child may take gym and play sports.
Jock itch is not easily spread to others. The fungus can't grow on dry, normal skin.
Check for Athlete's Foot:
If also has itchy rash of toes or feet, see Athlete's Foot care guide.
Until gone, use a separate towel to dry the feet.
Call Your Doctor if:
Rash is not better after 1 week on treatment
Rash is not gone after 4 weeks on treatment
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A scalp infection with tiny gray bugs called lice
Lice lay many white eggs (nits) in the hair
Symptoms of Head Lice
The eggs are easier to see than the lice. Nits (eggs) are tiny white specks attached to hairs. Unlike dandruff or sand, nits can't be shaken off the hair shafts.
Itching of the scalp is the main symptom.
A scalp rash may be present. The back of the neck is the favorite area.
Cause
Lice are 1/16-inch (2 mm) long gray-colored bugs. They move quickly and are difficult to see.
They are the size of a sesame seed.
The lice feed on blood from the scalp. While the bug is sucking blood, some of its secretions get mixed in. Any scalp rash or bumps is the body's reaction to the bug's saliva.
Lifespan of Lice
The nits (eggs) hatch into lice in about 1 week.
Nits (eggs) that are over ½ inch (1 cm) from the scalp are empty egg cases. They are very white in color.
Off the scalp, nits (eggs) can't survive over 2 weeks.
Adult lice survive 3 weeks on the scalp or 24 hours off the scalp.
Transmission of Head Lice: Live Lice, Not Nits
Only live lice can give lice to another child.
Nits (lice eggs) cannot pass on lice. Nits are attached to the child's hair.
Almost all spread of lice is from direct hair-to-hair contact. Lice cannot jump or fly to another person's hair.
The spread of lice from hats, hair brushes or combs is not common. Headphones and other objects also do not usually spread lice.
Most often, the spread of lice to others occurs at home, not school. Sleepovers and bed-sharing are a major source.
When To Call
Call Doctor Within 24 Hours
Age less than 2 months old
Scalp looks infected (such as pus, soft scabs, open sores)
Call Doctor During Office Hours
You think your child needs to be seen
Not sure your child has head lice
New head lice or nits are seen after treatment
Scalp rash or itch lasts more than 7 days after treatment
You have other questions or concerns
Self Care at Home
Head lice
Care Advice
What You Should Know About Head Lice:
Head lice can be treated at home.
With careful treatment, all lice and nits (lice eggs) are usually killed.
There are no lasting problems from having head lice.
They do not carry any diseases.
They do not make your child feel sick.
Here is some care advice that should help.
Anti-Lice Shampoo:
Buy some anti-lice creme rinse (such as Nix) and follow package directions. No prescription is needed.
First, wash the hair with a regular shampoo. Then, towel dry it before using the anti-lice creme. Do not use a conditioner or creme rinse after shampooing. Reason: It will interfere with Nix.
Pour 2 ounces (full bottle or 60 mL) of Nix into damp hair. People with long hair may need to use 2 bottles.
Work the creme into all the hair down to the roots.
If needed, add a little warm water to work up a lather.
Nix is safe above 2 months old.
Leave the shampoo on for a full 10 minutes. If you don't, it won't kill all the lice. Then rinse the hair well with water and dry it with a towel.
Repeat the anti-lice shampoo in 9 days. Be sure to do this or the lice may come back. Two treatments are always needed. The second treatment will kill any new lice that have hatched from eggs.
Remove the Dead Nits:
Nit removal is not necessary. It should not interfere with the return to school.
Some schools, however, have a no-nit policy. They will not allow children to return if nits are seen. The American Academy of Pediatrics advise that no-nit policies be no longer used. The National Association of School Nurses also takes this stand. If your child's school has a no-nit policy, call your child's doctor.
Reasoning: Only live lice can spread lice to another child. One treatment with Nix kills all the lice.
Nits (lice eggs) do not spread lice. Most treated nits (lice eggs) are dead after the first treatment with Nix. The others will be killed with the 2nd treatment.
Removing the dead nits is not essential or urgent. However, it prevents others from thinking your child still has untreated lice.
Nits can be removed by backcombing with a special nit comb.
You can also pull them out one at a time. This will take a lot of time.
Wetting the hair with water makes removal easier. Avoid any products that claim they loosen the nits. (Reason: Can interfere with Nix)
Hairwashing Precautions to Help Nix Work:
Don't wash the hair with shampoo until 2 days after Nix treatment.
Avoid hair conditioners before treatment. Do not use them for 2 weeks after treatment. Reason: Coats the hair and interferes with Nix.
Treating Close Contacts:
Check the heads of everyone else living in your home. If lice or nits are seen, they also should be treated. Use the anti-lice shampoo on them as well.
Also, anyone with an itchy scalp rash should be treated.
Bedmates of children with lice should also be treated. If in doubt, have your child checked for lice.
Return to School:
Lice are spread by close contact. They cannot jump or fly.
Your child can return to school after 1 treatment with the anti-lice shampoo.
A child with nits doesn't need to miss any school or child care. Nits do not spread to others, nor
do they cause lice in others.
Remind your child not to share combs and hats.
Be sure to tell the school nurse or child care center director. She can check other students in your child's class.
Cleaning the House - Preventing Spread:
Avoid close contact with others until after the first anti-lice treatment.
Lice that are off the body rarely cause infection. Reason: Lice can't live for over 24 hours off the human body. Vacuum your child's room.
Soak hair brushes for 1 hour in a solution containing some anti-lice shampoo.
Wash your child's sheets, blankets, and pillow cases. Wash any clothes worn in the past 2 days. Wash in hot water (130° F or 54° C). This kills lice and nits.
Items that can't be washed (hats, coats, or scarves) should be set aside. Put them in sealed plastic bags for 2 weeks. This is the longest period that nits can survive. (Note: This is an option. This step probably is not needed.)
What to Expect:
With 2 treatments, all lice and nits should be killed.
If lice come back, it can mean another contact with an infected person. It can also be that the shampoo wasn't left on for 10 minutes. It may also mean that hair conditioner was used.
Also, make sure the Nix is repeated in 9 days. If you don't, the lice may come back.
Call Your Doctor If:
New lice or nits are seen in the hair
Scalp rash or itch lasts more than 1 week after the anti-lice shampoo
Sores on scalp start to spread or look infected
You think your child needs to be seen
Your child becomes worse
Extra Care Advice - Cetaphil Cleanser for Nix Treatment Failures:
Go to your drugstore and buy Cetaphil cleanser in the soap department. No prescription is needed. It works by coating the lice and suffocating them.
Apply the Cetaphil cleanser throughout the scalp to dry hair.
After all the hair is wet, wait 2 minutes for Cetaphil to soak in.
Comb out as much excess cleanser as possible.
Blow dry your child's hair. It has to be thoroughly dry down to the scalp to suffocate the lice. Expect this to take 3 times longer than normal drying.
The dried Cetaphil will smother the lice. Leave it on your child's hair for at least 8 hours.
In the morning, wash off the Cetaphil with a regular shampoo.
To cure your child of lice, repeat this process twice in 1 and 2 weeks.
The cure rate can be 97%.
Detailed instructions can be found online: Nuvo Method for Head Lice.
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Small raised growths that have a smooth, waxy surface
The medical name is molluscum contagiosum
Viral infection of the skin
A doctor has told you your child has molluscum or
Your child has had close contact with another person who has it
Symptoms of Molluscum
Small bumps with a waxy or pearl-colored, smooth surface
May have a dimple (indent) in center
Bumps are firm with a core of white material.
Are many different sizes, from pinhead to ¼ inch (3 to 6 mm) across
Can occur anywhere on the body, but usually stay in just one area
Are sometimes itchy, but not painful
Usually age 2 to 12 years
Most infected children get 5 to 10 of them
Cause of Molluscum
They are caused by a poxvirus. This is a different virus than the one that causes warts.
Friction or picking at them causes them to increase in number.
To Treat or Not to Treat?
Some doctors advise not treating them if there are only a few. Reason: They are harmless and painless.
They have a natural tendency to heal and go away on their own.
When Special Treatment is Considered
Your child picks at them
They are in areas of friction (for example, the armpit)
They are spreading quickly or
You feel they are a cosmetic problem
Prevent Spread to Others
Avoid baths or hot tubs with other children. Reason: Can spread in warm water.
Also, avoid sharing washcloths or towels.
Contact sports: Can spread to other team members. They should be covered or treated.
Time it takes to get them: 4 to 8 weeks after close contact.
When To Call
Call Doctor or Seek Care Now
Redness or red streak spreading from molluscum with fever
Your child looks or acts very sick
Call Doctor Within 24 Hours
Redness or red streak spreading from molluscum without fever
You think your child needs to be seen
Call Doctor During Office Hours
Molluscum on the face
4 or more molluscum
Your child can't stop picking at the molluscum
Pus is draining from the molluscum (Apply antibiotic ointment 3 times per day until seen)
On treatment more than 2 weeks and new molluscum appear
On treatment more than 12 weeks and molluscum not gone
You have other questions or concerns
Self Care at Home
Molluscum: 3 or less
Care Advice
What You Should Know About Molluscum:
They are harmless and painless.
Wart-removing acids are not helpful.
Duct tape treatment will make them go away faster.
Here is some care advice that should help.
Duct Tape - Cover the Molluscum:
Covering them with duct tape can irritate them. This turns on the body's immune system.
Cover as many of them as possible. (Cover at least 3 of them.)
The covered ones become red and start to die. When this happens, often all of them will go away.
Try to keep them covered all the time.
Remove the tape once per day, usually before bathing. Then replace it after bathing.
Some children don't like the tape on at school. At the very least, tape it every night.
Prevent the Spread to Other Areas of Your Child's Body:
Discourage your child from picking at them.
Picking it and scratching a new area with the same finger can spread them. A new one can form in 1 to 2 months.
Chewing or sucking on them can lead to similar bumps on the face.
If your child is doing this, cover them. You can use a bandage (such as Band-Aid).
Keep your child's fingernails cut short and wash your child's hands more often.
What to Expect:
Without treatment, they go away in 6 to 18 months.
If covered with duct tape, they may go away in 2 or 3 months.
If picked at often, they can become infected with bacteria. If this happens, they change into crusty sores (impetigo).
Return to School:
Your child doesn't have to miss any child care or school.
There is a mild risk of spread to others.
Call Your Doctor If:
Your child continues to pick at them
New ones develop after 2 weeks of treatment
They are still present after 12 weeks of treatment
You think your child needs to be seen
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Bites from a mosquito
Cause itchy, red bumps
Often they look like a hive
West Nile Virus (WNV) questions are also covered
Types of Reactions to Mosquito Bites
Red Bumps. In North America, mosquito bites are mainly an annoyance. They cause itchy red skin bumps. Often, the bite looks like hives (either one large one or several small ones).
When a mosquito bites, its secretions are injected into the skin. The red bumps are the body's reaction to this process.
Suspect mosquito bites if there are bites on other parts of the body. Most bites occur on exposed parts such as face and arms.
Swelling. Bites of the upper face can cause severe swelling around the eye. This can last for several days. With bites, the swelling can be pink as well as large (especially age 1-5 years).
Disease. Rarely, the mosquito can carry a serious blood-borne disease. In the US and Canada, this is mainly West Nile Virus (WNV). In Africa and South America, they also carry malaria and yellow fever.
Prevention. Insect repellents can prevent mosquito bites. Use DEET (applied to skin) and permethrin (applied to clothing).
Cause of Mosquito Bite Reaction
The skin bumps are the body's reaction to the mosquito's saliva.
While it's sucking blood, some of its secretions get mixed in.
Mosquito Life Cycle
Only female mosquitoes bite. They need a blood meal to produce eggs. The female may bite 20 times before she finds a small blood vessel. She then sips blood for 90 seconds.
Males eat flower nectar and plant juices.
170 species of mosquito are in North America.
At a far distance, they are attracted by smell (breath odors, sweat and perfumes). They can smell up to 120 feet (36 meters). At a close distance, they are attracted by body heat and movement.
Risk Factors for Increased Mosquito Bites
Warmer body temperature
Male more than female
Children more than adults
Breath odors
Sweating
Perfumed soaps and shampoos
Complications of Insect Bites
Impetigo. A local bacterial infection. Gives sores, soft scabs and pus. Caused by scratching or picking at the bites. More common in itchy bites.
Cellulitis. The bacterial infection spreads into the skin. Gives redness spreading out from the bite. The red area is painful to the touch.
Lymphangitis. The bacterial infection spreads up the lymph channels. Gives a red line that goes up the arm or leg. More serious because the infection can get into the bloodstream. (This is called sepsis.)
When To Call
Call 911 Now
Life-threatening allergic reaction suspected. Symptoms include sudden onset of trouble breathing or swallowing.
Can't wake up
You think your child has a life-threatening emergency
Go to ER Now
Hard to wake up
Acts or talks confused
Can't walk or can barely walk
Stiff neck (can't touch chin to the chest)
Call Doctor or Seek Care Now
Spreading red area or streak with fever
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Painful spreading redness started more than 24 hours after the bite. Note: any redness starting in the first 24 hours is a reaction to the bite.
More than 48 hours since the bite and redness gets larger
Unexplained fever and recent travel outside the country to high risk area
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Pregnant and recently traveled to or lives in a place with a Zika outbreak
Scab that looks infected (drains pus or gets bigger) not better with antibiotic ointment
Severe itching not better after 24 hours of using steroid cream
You have other questions or concerns
Self Care at Home
Normal mosquito bite
Questions about West Nile Virus
Questions about insect repellents (such as DEET)
Care Advice
Treatment for Mosquito Bites
What You Should Know About Mosquito Bites:
In the United States and Canada, mosquito bites rarely carry any disease.
They cause itchy red skin bumps.
Most of the time, the bumps are less than ½ inch (12 mm) in size. In young children, they can be larger.
Some even have a small water blister in the center.
A large hive at the bite does not mean your child has an allergy.
The redness does not mean the bite is infected.
Here is some care advice that should help.
Steroid Cream for Itching:
To reduce the itching, use 1% hydrocortisone cream (such as Cortaid). No prescription is needed. Put it on 3 times a day until the itch is gone. If you don't have, use a baking soda paste until you can get some.
If neither is available, use ice in a wet washcloth for 20 minutes.
Also, you can put firm, sharp, direct, steady pressure on the bite. Do this for 10 seconds to reduce the itch. A fingernail, pen cap, or other object can be used.
Allergy Medicine for Itching:
If the bite is still itchy, try an allergy medicine (such as Benadryl). No prescription is needed.
Sometimes it helps, especially in allergic children.
Try Not to Scratch:
Cut the fingernails short.
Help your child not to scratch.
Reason: Prevent a skin infection at the bite site.
Antibiotic Ointment:
If the bite has a scab and looks infected, use an antibiotic ointment. An example is Polysporin.
No prescription is needed. Use 3 times per day. (Note: Usually infection caused by scratching bites with dirty fingers).
Cover the scab with a bandage (such as Band-Aid). This will help prevent scratching and spread.
Wash the sore and use the antibiotic ointment 3 times per day. Do this until healed.
What to Expect:
Most mosquito bites itch for 3 or 4 days.
Any pinkness or redness lasts 3 or 4 days.
The swelling may last 7 days.
Bites of the upper face can cause severe swelling around the eye. This does not hurt the vision and is harmless.
The swelling is often worse in the morning after lying down all night. It will improve after standing for a few hours.
Call Your Doctor If:
Bite looks infected (redness gets larger after 48 hours)
Bite becomes painful
You think your child needs to be seen
Your child becomes worse
West Nile Virus Questions
West Nile Virus (WNV) - What You Should Know:
WNV is a disease carried by mosquitoes. It can be spread to humans through a mosquito bite.
About 1% of mosquitoes carry WNV.
Of people who get WNV, less than 1% get the serious kind.
Here are some facts that should help.
Symptoms of WNV:
No symptoms: 80% of WNV infections.
Mild symptoms: 20% of infections. Symptoms include fever, headache, and body aches. Some have a skin rash. These symptoms last 3-6 days. They go away without any treatment. This is called WNV fever.
Serious symptoms: less than 1% (1 out of 150) of WNV infections. Symptoms are high fever, stiff neck, confusion, coma, seizures, and muscle weakness. The muscle weakness is often just on one side. The cause is infection of the brain (encephalitis) or spinal cord (viral meningitis).
Death: 10% of those who need to be in the hospital.
Child cases are most often mild. Most serious cases occur in people over age 60.
Diagnosis of WNV:
Mild symptom cases do not need to see a doctor. They do not need any special tests.
Severe symptom cases (with encephalitis or viral meningitis) need to see a doctor right away. Special tests on the blood and spinal fluid will be done to confirm WNV.
Pregnant or nursing women need to see a doctor if they have WNV symptoms.
Treatment of WNV:
No special treatment is needed after a mosquito bite.
There is no special treatment or anti-viral drug for WNV symptoms.
People with serious symptoms often need to be in the hospital. They will be given IV fluids and airway support.
There is not yet a vaccine to prevent WNV in humans.
WNV - Spread by Mosquitoes:
WNV is spread by the bite of a mosquito. The mosquito gets the virus from biting infected birds.
Even in an area where WNV occurs, less than 1% of mosquitoes carry the virus.
Spread is mosquito-to-human.
Person-to-person spread does not occur. Kissing, touching, or sharing a glass with a person who has WNV is safe.
Mothers with mosquito bites can breastfeed (CDC 2003), unless they get symptoms of WNV.
It takes 3-14 days after the mosquito bite to get WNV.
In United States and Canada, the peak summers for WNV were 2002, 2003 and 2012.
Insect Repellent Questions
Prevention Tips:
Wear long pants, a long-sleeved shirt and a hat.
Avoid being outside when the bugs are most active. Mosquitoes are most active at dawn and dusk. Limit your child's outdoor play during these times.
Get rid of any standing water. (Reason: It's where they lay their eggs.)
Keep bugs out of your home by fixing any broken screens.
Insect repellents containing DEET are very good at preventing mosquito bites. Read the label carefully.
DEET Products - Use on the Skin:
DEET is a good mosquito repellent. It also repels ticks and other bugs.
The AAP approves DEET use over 2 months old. Use 30% DEET or less. Use 30% DEET if you need 6 hours of protection. Use 10% DEET if you only need protection for 2 hours.
Don't put DEET on the hands if your child sucks their thumb or fingers. (Reason: Prevent swallowing DEET)
Warn older children who apply their own DEET to use less. A total of 3 or 4 drops can protect the whole body.
Put on exposed areas of skin. Do not use near eyes or mouth. Don't use on skin that is covered by clothing. Don't put DEET on sunburns or rashes. (Reason: DEET can be easily absorbed in these areas.)
Wash it off with soap and water when your child comes indoors.
Caution: DEET can damage clothing made of man-made fibers. It can also damage plastics (eye glasses) and leather. DEET can be used on cotton clothing.
Permethrin Product - Use on Clothing:
Products that contain permethrin (such as Duranon) work well to repel mosquitos and ticks.
Unlike DEET, these products are put on clothing instead of on the skin.
Put it on shirt cuffs, pant cuffs, shoes and hats. Can also put it on mosquito nets and sleeping bags.
Do not put permethrin on the skin. (Reason: Sweat changes it so it does not work).
Picaridin Products:
Picaridin is a repellent that is equal to 10% DEET.
It can safely be put on skin or clothing.
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Normal skin rashes and birthmark questions about newborns
Newborn Rashes - Topics Covered
If your baby is healthy, skip the "What to Do" section. Go directly to the topic number that relates to your question for advice.
Acne. Small red bumps on the face (onset 2-4 weeks).
Drooling or Spit-Up Rash. Rash around the mouth and on the chin (onset anytime).
Erythema Toxicum. Red blotches with small white "pimple" in the center (onset 2-3 days).
Skin Injury from Birth Process. From forceps, scalp electrode or birth canal (present at birth).
Milia. Tiny white bumps on the nose and cheeks (present at birth).
Mongolian Spots. Bluish-green birthmark, often on buttock (present at birth).
Stork Bites (Pink Birthmarks). On back of neck or bridge of nose (present at birth).
Strawberry Hemangiomas. Raised red birthmarks (onset 2-4 weeks).
Port-wine Stains. Dark red or purple flat birthmarks (present at birth).
Newborn Face Rashes: Most Common Ones
Erythema Toxicum 50% (onset day 2 or 3)
Milia 40% (present at birth)
Baby Acne 30% (onset week 2 to 4)
Drooling or Spit-up Rash (common and onset any time)
Heat Rash (common and onset any time)
Heat Rash
Many newborn rashes that have no clear cause are heat rashes.
Heat rashes are a pink blotchy area with tiny bumps.
They mainly occur on the face, neck and chest.
During hot weather, most temporary newborn rashes are heat rashes.
Cause: blocked off sweat glands. The openings are so tiny in newborns, that any irritation can block them. Examples are getting any ointment on the skin, friction from clothing or being overheated. Being held against the mother's skin while nursing causes many face rashes.
Herpes Simplex: Serious Newborn Rash
Appearance. Several water blisters or pimples grouped in a cluster. They look like the cold sores (fever blisters) that adults get on their lip. After several days, they crust over.
Location. Just one part of the body, usually the scalp or face.
Redness. The base can be pink. The pinkness does not extend beyond the cluster of vesicles.
Onset. Within the first 2 weeks of life.
Importance. Early treatment with anti-viral drugs can prevent serious problems. If you think your newborn's rash looks like herpes, call your child's doctor now.
Imitator. Although herpes can be confused with erythema toxicum, they look very different.
When To Call
Call 911 Now
Not moving or very weak
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Age less than 1 month old and looks or acts abnormal in any way
Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.
Purple or blood-colored spots or dots not present at birth
Tiny blisters (little bumps that contain clear fluid)
Pimples (little bumps that contain pus). Exception: looks like erythema toxicum which occurs in half of newborns.
Skin looks infected (such as spreading redness, sores or pus)
Rash is painful to touch
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Mild newborn rash, but cause is not clear
You have other questions or concerns
Self Care at Home
Normal newborn rashes or birthmarks
Care Advice
Acne:
More than 30 percent of newborns develop baby acne of the face. Acne consists of small red bumps.
This baby acne begins at 2 to 4 weeks of age. It lasts until 4 to 6 months of age.
The cause appears to be the transfer of maternal hormones just prior to birth.
Since it goes away on its own, no treatment is needed. Baby oil or ointments make it worse.
Drooling or Spit-up Rash:
Many babies have a rash on the chin or cheeks that comes and goes. This is often due to contact with food. It's more common after starting baby foods. In newborns, it can also be from stomach acid that has been spit up. Prolonged contact with spit-up during sleep can cause the rash to get worse.
Other temporary rashes on the face are heat rashes. These can occur in areas held against the mother's skin during nursing. Heat rashes are more common in the summertime.
Rinse the face with water after all feedings or spitting up. During hot weather, change the baby's position more often. Also, put a cool wet washcloth on the rash. Do this for 10 minutes.
Erythema Toxicum:
More than 50 percent of babies get a rash called erythema toxicum. It starts on the second or third day of life.
It's a harmless baby rash that doesn't need to be seen.
The rash is made up red blotches. They are ½ inch to 1 inch (1 to 2.5 cm). The blotches have a small white or yellow "pimple" in the center.
They look like insect bites, but are not. Red blotches are the main feature.
They can be numerous, keep occurring, and look terrible. They can occur anywhere on the body surface, except the palms and soles.
Their cause is unknown, but they are not an infection.
They go away by 1-2 weeks of age.
No treatment is needed. Ointments or baby oil make it worse.
Skin Injury from Forceps, Scalp Electrode or Birth Canal:
The pressure of a forceps on the skin can leave marks. You may see bruises or scrapes anywhere on the head or face.
During birth, skin overlying bony prominences can become damaged. You might see this on the sides of the skull bone. This is from pressure from the birth canal. Even without a forceps delivery, you may see bruises or scrapes.
Scalp electrodes can also cause scalp scrapes and scabs.
The bruises and scrapes will be noted at birth. They will be more noticeable by day 2. They heal over or go away by 1 - 2 weeks of age.
A fat tissue injury won't appear until day 5 to 10. Look for a firm coin-shaped lump. It will be under the skin and sometimes with a scab. This lump may take 3 or 4 weeks to go away.
For any breaks in the skin, apply an antibiotic ointment (such as Polysporin). No prescription is needed. Use 3 times per day until healed.
Call Your Doctor If:
It becomes tender to the touch
Becomes soft in the center
Starts to looks infected
Milia:
Milia are tiny white bumps that occur on the face. The nose and cheeks are most often involved. Milia can also be seen on the forehead and chin.
Milia occur in 40 percent of newborn babies. Present at birth.
Milia are many in number. They occur equally on both sides of the face.
Although they look like pimples, they are much smaller (pinhead size). They are not infected.
They do not look like water blisters.
They are blocked-off skin pores. They will open up.
Milia will go away by 1 to 2 months of age.
No treatment is needed. Ointments or creams can make them worse.
Mongolian Spots:
A Mongolian spot is a normal bluish-green or bluish-grey flat birthmark. They occur in over 90 percent of Native American, Asian, Hispanic, and African American babies. They are also seen in 10 percent of Caucasians, especially those of Mediterranean descent.
They are present at birth.
They occur most commonly over the back and buttocks. However, they can be present on any part of the body.
They vary greatly in size and shape.
They do not indicate illness or any disease.
Most fade away by 2 or 3 years of age. A trace may persist into adult life.
Stork Bites (Pink Birthmarks):
Flat pink birthmarks that occur over the bridge of the nose or the eyelids. You can also find them on the back of the neck ("stork bites"). The ones in front are often referred to as "an angel's kiss".
They occur in more than 50 percent of newborns. They are present at birth.
All the birthmarks on the bridge of the nose and eyelids clear completely. Those on the eyelids clear by 1 year of age. Those on the bridge of the nose may persist for a few more years. Those on the forehead from the nose up to the hairline usually persist into adulthood. Laser treatment during infancy should be considered. Most birthmarks on the nape of the neck also clear. But, 25 percent can persist into adult life.
Strawberry Hemangiomas:
Strawberry hemangiomas are red birthmarks that are raised or increasing in size.
Onset usually between 2-4 weeks of age. Most often, start after 3 weeks of age. Sometimes (although rare), they don't appear until the second month of life.
They become larger for 1 year. Then, they fade away over 6 to 8 years without any treatment.
They run a small risk of bleeding with trauma. Any bleeding should stop with 10 minutes of direct pressure.
Discuss with your child's doctor on the next regular visit. Call sooner if you are concerned.
Port-Wine Stain Birthmarks:
Present at birth in 1 out of 200 newborns
Deeper in color (dark red or purple) than stork bites (salmon patches)
Flat, smooth surface
Natural course: Do not fade or disappear like stork bites. May become darker.
Grow with the child, but cover the same area
Treatment: May refer to dermatologist for laser treatments early in infancy
Call Your Doctor If:
Your baby starts to look or act abnormal in any way
You think your child needs to be seen
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A very itchy rash with blisters
Caused by contact with the poison ivy plant
Symptoms of Poison Ivy
Rash is shaped like streaks or lines.
Red streaks with weeping blisters.
Rash found on exposed body surfaces (such as the hands). Also, can be on areas touched by the hands. Areas that can be affected in this way are the face or genitals.
Very itchy.
Onset 1 or 2 days after child was in a forest or field.
Cause
Caused by oil from poison ivy, poison oak, and poison sumac plants.
The oil is found in the leaves, stems, berries and roots of the plant.
Oil may be carried on pet's fur.
The oil from the plant causes the skin to itch, turn red and blister.
When To Call
Go to ER Now
Trouble breathing or severe coughing after being near to burning weeds
Call Doctor or Seek Care Now
Fever and looks infected (spreading redness or pus)
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Looks infected (spreading redness or pus) and no fever
Swelling is severe (such as the eyes are swollen shut)
Severe poison ivy reaction in the past
Rash covers more than one fourth of the body
Face, eyes, lips or genitals have a rash
Severe itching (such as can't sleep)
Big blisters or sores
Taking oral steroids for more than 24 hours and rash getting worse
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Rash lasts more than 3 weeks
You have other questions or concerns
Self Care at Home
Mild poison ivy or sumac rash
Care Advice
What You Should Know About Poison Ivy:
Poison ivy is caused by skin contact with the oil from the plant.
The oil can also come from the fur of outdoor pets.
Most poison ivy rashes can be treated at home.
Here is some care advice that should help.
Steroid Cream for Itching:
To help with the itch, put 1% hydrocortisone cream (such as Cortaid) on the rash.
No prescription is needed.
Use 3 times per day.
Cold Soaks for Itching:
Soak the involved area in cool water for 20 minutes.
You can also rub the rash with an ice cube.
Do as often as needed to help the itching and oozing.
Allergy Medicine for Itching:
If itching persists, give an allergy medicine (such as Benadryl) by mouth.
Use every 6 hours as needed.
No prescription is needed.
Try Not to Scratch:
Cut the fingernails short.
Help your child not to scratch.
Reason: Prevent a skin infection from bacteria.
More Poison Ivy - Prevention:
New blisters may occur several days after the first ones. This means your child probably has ongoing contact with poison ivy oil.
To prevent it from coming back, bathe all dogs or other pets.
Wash all clothes and shoes that your child wore on the day of contact.
Return to School:
Poison ivy or oak cannot be spread to others.
The fluid from the blisters or rash can't cause poison ivy.
No need to miss any school or child care.
What to Expect:
Most often, the rash lasts 2 weeks.
Treatment can reduce the severity of symptoms.
Treatment does not change how long they last.
Call Your Doctor If:
Poison ivy lasts for more than 3 weeks
It looks infected
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
The skin is punctured by a pointed narrow object
Causes of Puncture Wounds
Metal: nail, sewing needle, pin, tack
Pencil: pencil lead is actually graphite (harmless). It is not poisonous lead. Even colored leads are not toxic.
Wood: toothpick
Complications of Puncture Wounds
Retained Foreign Object. This happens if part of the sharp object breaks off in the skin. The pain will not go away until it is removed.
Wound Infection. This happens in 4% of foot punctures. The main symptom is spreading redness 2 or 3 days after the injury.
Bone Infection. If the sharp object also hits a bone, the bone can become infected. Punctures of the ball of the foot are at greatest risk. The main symptoms are increased swelling and pain 2 weeks after the injury.
When To Call
Call 911 Now
Deep puncture on the head, neck, chest, back or stomach
You think your child has a life-threatening emergency
Go to ER Now
Bleeding that won't stop after 10 minutes of direct pressure
Puncture on the head, neck, chest, or stomach that could be deep
Tip of the object broke off in the body
Call Doctor or Seek Care Now
Puncture into a joint
Feels like something is still in the wound
Won't stand (bear weight or walk) on punctured foot
Needlestick from used needle (may have been exposed to another person's blood)
Sharp object or setting was very dirty (such as a playground or dirty water)
No past tetanus shots
Dirt in the wound is not gone after 15 minutes of scrubbing
Severe pain and not better 2 hours after taking pain medicine
Wound looks infected (spreading redness, red streaks)
Fever occurs
You think your child has a serious injury
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Last tetanus shot was more than 5 years ago
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Minor puncture wound
Care Advice
What You Should Know About Puncture Wounds:
Most puncture wounds do not need to be seen.
Here is some care advice that should help.
Cleaning the Wound:
First wash off the foot, hand or other punctured skin with soap and water.
Then soak the puncture wound in warm soapy water for 15 minutes.
For any dirt or debris, gently scrub the wound surface back and forth. Use a wash cloth to remove any dirt.
If the wound re-bleeds a little, that may help remove germs.
Antibiotic Ointment:
Use an antibiotic ointment (such as Polysporin). No prescription is needed.
Then, cover with a bandage (such as Band-Aid). This helps to reduce the risk of infection.
Re-wash the wound and put on antibiotic ointment every 12 hours.
Do this for 2 days.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
What to Expect:
Puncture wounds seal over in 1 to 2 hours.
Pain should go away within 2 days.
Call Your Doctor If:
Dirt in the wound still there after 15 minutes of scrubbing
Pain becomes severe
Looks infected (redness, red streaks, pus, fever)
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.
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Definition
Red or pink rash on one small part of the body (localized)
Small spots, large spots or solid redness
Includes redness from skin irritation
Causes of Localized Rash or Redness
Irritants. A rash in just one spot is usually caused by skin contact with an irritant.
Plants. Many plants cause skin reactions. Sap from evergreens can cause a red area.
Pollen. Playing in the grass can cause a pink rash on exposed skin.
Pet Saliva. Some people get a rash where a dog or cat has licked them.
Food. Some children get a rash if a food is rubbed on the skin. An example could be a fresh fruit. Some babies get hives around the mouth from drooling while eating a new food.
Chemicals. Many of the products used in the home can be irritating to the skin.
Insect Bite. Local redness and swelling is a reaction to the insect's saliva. Can be very large without being an allergy. Kids often get mosquito bites without anyone noticing it.
Bee Sting. Local redness and swelling is a reaction to the bee's venom. Can be very large without being an allergy.
Cellulitis. This is a bacterial infection of the skin. The main symptom is a red area that keeps spreading. Starts from a break in the skin (such as a scratched insect bite). The red area is painful to the touch.
Other Common Causes. Look at the "See Other Care Guide" section. 8 rashes that you may be able to recognize are listed there. If you suspect one of them, go there. If not, use this guide.
Localized Versus Widespread Rash: How to Decide
Localized means the rash occurs on one small part of the body. Usually, the rash is just on one side of the body. An example is a rash on 1 foot. Exceptions: athlete's foot can occur on both feet. Insect bites can be scattered.
Widespread means the rash occurs on larger areas. Examples are both legs or the entire back. Widespread can also be on most of the body surface. Widespread rashes always occur on matching (both) sides of the body. Many viral rashes are on the chest, stomach and back.
The cause of a widespread rash usually goes through the blood stream. Examples are rashes caused by viruses, bacteria, toxins, and food or drug allergies.
The cause of a localized rash usually is just from contact with the skin. Examples are rashes caused by chemicals, allergens, insect bites, ringworm fungus, bacteria or irritants.
This is why it's important to make this distinction.
Contact Dermatitis
Contact dermatitis is a common cause of a rash in one area. This is especially true of a small rash that will not go away. Contact dermatitis usually starts as raised red spots. It can change to blisters, as in poison ivy. The rash is itchy. Contact dermatitis is an allergic skin rash. The location of the rash may suggest the cause:
Poison ivy or oak: exposed areas, such as the hands.
Nickel (metal): anywhere the metal has touched the skin. (Neck from necklaces, earlobe from earrings, or fingers from rings. Stomach from metal snap inside pants, wrist from watch, or face from eyeglass frames.)
Tanning agents in leather: tops of the feet from shoes or hands from leather gloves
Preservatives in creams, lotions, cosmetics, sunscreens, shampoos: where applied
Neomycin in antibiotic ointment: where applied
When To Call
Call 911 Now
Not moving or too weak to stand
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Purple or blood-colored spots or dots that's not from injury or friction
Age less than 1 month old and tiny water blisters
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Bright red area or red streak (but not sunburn)
Rash is very painful
Fever is present
Severe itching
Looks like a boil, infected sore or other infected rash
Teenager with a rash on the genitals
Lyme disease suspected (bull's eye rash and tick bite or contact)
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Blisters without a clear cause. Exception: Poison Ivy.
Pimples (Use an antibiotic ointment until seen)
Rash grouped in a stripe or band
Peeling fingers
Rash lasts more than 7 days
You have other questions or concerns
Self Care at Home
Mild localized rash or redness
Care Advice
What You Should Know About Localized Rashes:
Most new localized rashes are due to skin contact with an irritating substance.
Here is some care advice that should help.
Avoid the Cause:
Try to find the cause.
Consider irritants like a plant (such as evergreens or weeds). Also, chemicals (such as solvents or insecticides). Irritants also can include fiberglass or detergents. A new cosmetic or new jewelry (such as nickel) may also be the cause.
A pet may carry the irritant, as with poison ivy or oak. Also, your child could react directly to pet saliva.
Review the list of causes for contact dermatitis.
Do Not Use Soap:
Wash the red area once with soap to remove any remaining irritants.
Then, do not use soaps on it. Reason: Soaps can slow healing.
Cleanse the area when needed with warm water.
Cold Soaks for Itching:
Use a cold wet washcloth or soak in cold water for 20 minutes.
Do this every 3 to 4 hours as needed. This will help with itching or pain.
Steroid Cream for Itching:
If the itch is more than mild, use 1% hydrocortisone cream (such as Cortaid). Put it on the rash.
No prescription is needed.
Use it 3 times per day.
Exception: Do not use for suspected ringworm.
Try Not to Scratch:
Help your child not to scratch.
Cut the fingernails short.
Return to School:
Children with localized rashes do not need to miss any child care or school.
What to Expect:
Most of these rashes go away in 2 to 3 days.
Call Your Doctor If:
Rash spreads or gets worse
Rash lasts for more than 1 week
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Red or pink rash over large parts or most of the body (widespread)
Sometimes, just on hands, feet and buttocks - but same on both sides of body
Small spots, large spots or solid red skin
Causes of Widespread Rash or Redness
Viral Rash. Most rashes are part of a viral illness. Viral rashes usually have small pink spots. They occur on both sides of the chest, stomach and back. Your child may also have a fever with some diarrhea or cold symptoms. They last 2 or 3 days. More common in the summer.
Roseola. This is the most common viral rash in the first 3 years of life. (See details below).
Chickenpox. A viral rash with a distinctive pattern. (see that Care Guide)
Hand-Foot and-Mouth Disease. A viral rash with a distinctive pattern. It starts with tiny red spots and blisters on the palms and soles. (see that Care Guide)
Scarlet Fever. Scarlet Fever is a speckled, red rash all over. Caused by the Strep bacteria. Starts on upper chest and quickly spreads to lower chest and stomach. No more serious than a Strep throat infection without a rash.
Drug Rash. Most rashes that start while taking an antibiotic are viral rashes. Only 10% turn out to be allergic drug rashes. (see details below)
Hives. Raised pink bumps with pale centers. Hives look like mosquito bites. Rashes that are bumpy and itchy are often hives. Most cases of hives are caused by a virus. Hives can also be an allergic reaction. (See that Care Guide for details)
Heat Rash. A fine pink rash caused by overheating. Mainly involves neck, chest and upper back.
Insect Bites. Insect bites cause small red bumps. Flying insects can cause many bumps on exposed skin. Non-flying insects are more likely to cause localized bumps.
Hot Tub Rash. Causes small red bumps that are painful and itchy. Mainly occurs on skin covered by a bathing suit. Rash starts 12-48 hours after being in hot tub. Caused by overgrowth of bacteria in hot tubs.
Petechiae Rash (Serious). Petechiae are purple or dark red colored tiny dots. They come from bleeding into the skin. Scattered petechiae with a fever are caused by Meningococcemia until proven otherwise. This is a life-threatening bacterial infection of the bloodstream. Peak age is 3 to 6 months old. Unlike most pink rashes, petechiae don't fade when pressed on.
Purpura Rash (Serious). Purpura means bleeding into the skin. It looks like purple or dark red larger spots. Widespread purpura is always an emergency. It can be caused by a bacterial bloodstream infection. Rocky Mountain Spotted Fever is an example.
Blister Rash (Serious). Widespread blisters on the skin are a serious sign. It can be caused by infections or drugs. Stevens Johnson Syndrome is an example.
Caution. All widespread rashes with fever need to be seen. They need to be diagnosed. Reason: some serious infections that can cause this type of rash.
Drugs and Rashes
Prescription medicines sometimes cause widespread rashes. Some are allergic, but most are not.
Non-prescription (OTC) medicines rarely cause any rashes.
Most rashes that occur while taking an OTC medicine are viral rashes.
Fever medicines (acetaminophen and ibuprofen) cause the most needless worry. Reason: most viral rashes start with a fever. Hence, the child is taking a fever medicine when the rash starts.
Drug rashes can't be diagnosed over the phone.
Roseola - A Classic Rash
Most children get Roseola between 6 months and 3 years of age.
Rash: pink, small, flat spots on the chest and stomach. Then spreads to the face.
Classic feature: 2 or 3 days of high fever without a rash or other symptoms.
The rash starts 12 to 24 hours after the fever goes away.
The rash lasts 1 to 3 days.
By the time the rash appears, the child feels fine.
Treatment: the rash is harmless. Creams or medicines are not needed.
Localized Versus Widespread Rash: How to Decide
Localized means the rash occurs on one small part of the body. Usually, the rash is just on one side of the body. An example is a rash on 1 foot. Exceptions: athlete's foot can occur on both feet. Insect bites can be scattered.
Widespread means the rash occurs on larger areas. Examples are both legs or the entire back. Widespread can also mean on most of the body surface. Widespread rashes always occur on matching (both) sides of the body. Many viral rashes are on the chest, stomach and back.
The cause of a widespread rash usually spreads through the blood stream. Examples are rashes caused by viruses, bacteria, toxins, and food or drug allergies.
The cause of a localized rash usually is just from contact with the skin. Examples are rashes caused by chemicals, allergens, insect bites, ringworm fungus, bacteria or irritants.
This is why it's important to make this distinction.
When To Call
Call 911 Now
Purple or blood-colored spots or tiny dots with fever within the last 24 hours
Trouble breathing or swallowing
Not moving or too weak to stand
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Purple or blood-colored spots or tiny dots without fever
Bright red skin that peels off in sheets
Large blisters on skin
Bloody crusts on the lips
Not alert when awake ("out of it")
Taking a prescription medication within the last 3 days
Fever
Your daughter is having her period and using tampons
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Widespread rash, but none of the symptoms above. Reason: all widespread rashes need to be checked by a doctor.
Care Advice
What You Should Know About Widespread Rashes:
Most rashes with small pink spots all over are part of a viral illness.
This is more likely if your child has a fever. Other symptoms (like diarrhea) also point to a viral rash.
Here is some care advice that should help until you talk with your doctor.
Non-Itchy Rash Treatment:
If you suspect a heat rash, give a cool bath.
Otherwise, no treatment is needed.
Itchy Rash Treatment:
Wash the skin once with soap to remove any irritants.
Steroid Cream. For relief of itching, use 1% hydrocortisone cream (such as Cortaid). Put it on the most itchy areas. No prescription is needed. Do this 3 times per day.
Cool Bath. For flare-ups of itching, give your child a cool bath. Do not use soap. Do this for 10 minutes. (Caution: Avoid any chill). Option: Can add 2 ounces (60 mL) of baking soda per tub.
Fever Medicine:
For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Note: Fevers less than 102° F (39° C) are important for fighting infections.
For all fevers: Keep your child well hydrated. Give lots of cold fluids.
Return to School:
Most viral rashes can be spread to others (especially if a fever is present).
If your child has a fever, avoid contact with other children. Also, avoid pregnant women until a diagnosis is made.
For minor rashes, your child can return after the fever is gone.
For major rashes, your child can return to school after the rash is gone. If your doctor has given medical clearance, your child can return sooner.
What to Expect:
Most viral rashes go away within 48 hours.
Call Your Doctor If:
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
One or more ring-shaped spots caused by a fungus
Has a rough edge and clearing of the center
Symptoms of Ringworm
Round pink patch
Clearing of the center as the patch grows
Raised, rough, scaly border
Usually ½ to 1 inch (12 -25 mm) in size
Ring slowly increases in size
Often only on one side of the face or body
Mildly itchy
Cause
An infection of the skin caused by a fungus. It is not caused by a worm.
Can often be spread to humans from puppies or kittens that have it. Pet rodents also can carry it.
Rarely, can be spread human-to-human. It needs direct skin contact to be passed this way. An exception is that ringworm can occur often among wrestlers. This is because of close body contact during matches.
Sometimes, caused by fungus in the soil.
When To Call
Call Doctor Within 24 Hours
Pus is draining from the rash
Call Doctor During Office Hours
Scalp is involved
More than 3 spots are present
Child is a wrestler
Rash gets bigger or spreads after 1 week on treatment
Rash lasts more than 4 weeks
You think your child needs to be seen
You have other questions or concerns
Self Care at Home
Mild ringworm
Care Advice
What You Should Know About Ringworm:
Ringworm is a fungus infection of the skin.
Often it's caught from puppies or kittens that have it.
Here is some care advice that should help.
Anti-Fungal Cream:
Use an anti-fungal cream (such as Lotrimin) 2 times per day. No prescription is needed.
Put it on the rash and 1 inch (2.5 cm) beyond its borders.
Keep using the cream for at least 7 days after the rash is cleared.
Return to School:
Your child doesn't have to miss any child care or school for ringworm.
Sometimes, ringworm of the skin can be passed on to others. It requires direct skin-to-skin contact.
Ringworm from pets is not passed from human to human. It is only passed from animal to human.
After 48 hours of treatment, ringworm does not spread to others at all.
Wrestlers: Can return to wrestling after 3 days of treatment. Continue treatment until gone.
What to Expect:
It goes away in 3 to 4 weeks.
If it comes back, suspect the household puppy or kitten.
Take your animal to the vet for an exam and treatment.
Call Your Doctor If:
Rash gets bigger or spreads after 1 week on treatment
Rash is not gone by 4 weeks
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Widespread fine pink rash caused by Roseola virus
Classic feature is that the rash is preceded by 2 or 3 days of high fever
The fever goes away before the rash starts
A doctor has told you that your child probably has Roseola or
Rash occurs after several days of fever, but fever gone now
Symptoms of Roseola
Most children get Roseola between 6 months and 3 years of age.
Rash: Pink, small, flat spots on the chest and stomach. Rash is the same on both sides of the body. Then spreads to the face.
Classic feature: 2 or 3 days of high fever without a rash or other symptoms.
The rash starts 12 to 24 hours after the fever goes away.
The rash lasts 1 to 3 days.
By the time the rash appears, the child feels fine.
Cause of Roseola
Human herpes virus 6 (HHV6)
Viral Rashes and Drug Rashes
Prescription drugs sometimes cause widespread rashes.
Non-prescription (OTC) drugs rarely cause any rashes.
Most rashes that occur while taking an OTC drug are viral rashes.
Fever medicines (acetaminophen and ibuprofen) cause the most confusion. Reason: Most viral rashes start with a fever. Hence, the child is taking a fever med when the rash starts. But, the fever med had nothing to do with the rash.
Drug rashes can't be diagnosed over the phone.
Prevention
Good hand washing can prevent spread of infection.
When To Call
Call 911 Now
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Rash becomes purple or blood-colored
Large blisters on skin
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Fever comes back
Rash becomes worse
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Rash lasts more than 4 days
You have other questions or concerns
Self Care at Home
Roseola rash
Care Advice
What You Should Know About Roseola:
Most children get Roseola between 6 months and 3 years of age.
It's the most common rash in this age group.
By the time they get the rash, the fever is gone. The child feels fine.
The rash is harmless and goes away on its own.
Here is some care advice that should help.
Treatment:
No treatment is needed.
Creams or medicines are not helpful.
Moisturizing Cream for Itch:
Roseola usually is not itchy. If your child's rash is itchy, here are some tips.
Use a moisturizing cream (such as Eucerin) once or twice daily.
Apply the cream after a 5 or 10-minute bath. (Reason: Water-soaked skin feels less itchy).
Avoid all soaps. (Reason: Soaps, especially bubble bath, make the skin dry and itchy).
Fever Medicine:
For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Note: Fevers less than 102° F (39° C) are important for fighting infections.
For all fevers: Keep your child well hydrated. Give lots of cold fluids.
Note: By the time the rash occurs, the fever should be gone. If your child has both, see Rash or Redness - Widespread care guide.
What to Expect:
Roseola rash goes away in 2-3 days.
Some children with Roseola just have 3 days of fever without a rash.
Return to Child Care:
Once the rash is gone, the disease is no longer contagious.
Your child can return to child care or school.
Children exposed to your child earlier may come down with Roseola in 9-10 days.
Call Your Doctor If:
Fever comes back
Rash lasts more than 4 days
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A very itchy rash caused by the scabies mite
A mite is a tiny, invisible bug that burrows under the skin
A doctor has told you your child has scabies or
Your child has had close contact with another person who has it
Symptoms of Scabies
Widespread little red, bumpy rash that mainly involves the skin folds.
Intense itching is the main symptom. If it doesn't itch, it's not scabies.
Appearance. The small red bumps are often in short straight or wavy lines. These are the burrows/tunnels of the mite. The bump or water blister is where the mite entered the skin.
Location. Classic scabies is found in skin creases such as finger webs. Hands and wrists are the most common sites. Armpits, groin, scrotum, buttocks, navel, waist, and ankles can be involved.
The face and neck are usually spared. In infants, the rash can involve the face and scalp.
The rash usually looks the same on both sides of the body.
Cause of Scabies
Scabies mite
Scabies comes from skin-to-skin contact with someone who has scabies.
After contact, a person will come down with scabies rash in 4 to 6 weeks.
Itching is the first symptom.
The rash and itching are the body's allergic reaction to mites in the skin.
Can occur in anyone and does not mean poor hygiene.
Scabies mites do not carry any disease.
Prevention of Spread to Others
Scabies is very contagious and prevention is difficult.
It's best to treat everyone who has had close contact.
When To Call
Call Doctor or Seek Care Now
Spreading red area or streak with fever
Your child looks or acts very sick
Call Doctor Within 24 Hours
Spreading red area or streak, but no fever
You think your child needs to be seen
Call Doctor During Office Hours
Your child had close contact with someone with scabies and not treated
Yellow soft scab that drains pus or gets bigger, not better with antibiotic ointment
Severe itching not better after 48 hours of steroid cream and allergy medicine
Rash goes away with treatment and then returns
After 4 weeks, itch is still present
You have other questions or concerns
Self Care at Home
Scabies infection
Care Advice
What You Should Know About Scabies:
Scabies are easy to treat. Itching is the problem.
The itching normally lasts for 2 weeks after the scabies mites are killed.
Treatment with the anti-scabies cream does not help the itch.
The itching is an allergic reaction. The body reacts to the dead mites and eggs in the skin. It continues until all the skin containing the dead mites is shed. This usually takes 2 weeks.
Continuing to have the itch does not mean that the treatment didn't work. It also doesn't mean that it needs to be repeated.
Here is some care advice that should help.
Treating Close Contacts:
Scabies is easily spread to others. The symptoms don't start for an average of 30 days.
Therefore, everyone living in the house should be treated before they develop a rash.
Close contacts only need to be treated once with the scabies cream.
Anti-Scabies Medicine (Prescription):
Scabies is treated with a prescription cream. (Currently, the most common product is Elimite).
If applied correctly, it's almost 100% effective at curing scabies.
Apply the cream from the chin to the toes. Cover every square inch of the body. Don't forget the navel, between the toes, under the fingernails and all the creases.
Areas that don't seem infected still need to be covered with the cream.
Caution: Infants less than 1 year old also need the cream applied to the head. Put it on the scalp, forehead, temples, ears and neck. Avoid putting it around the eyes and mouth.
Bedtime is usually the best time to apply it.
Eight to 12 hours later give your child a bath with warm water. This will remove the cream.
One treatment is usually effective. For severe rashes, repeat the treatment 1 week later.
Approved for as young as 2 months old.
Steroid Cream for Itching:
For relief of itching, apply 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
Do this 3 times per day to the most itchy spots.
Allergy Medicine for Itching:
For severe itching, an oral allergy medicine (such as Benadryl) should help.
Age Over 1 Year: Give Benadryl 4 times per day. No prescription is needed.
Age Over 2 Years: Another option is to give cetirizine (such as Zyrtec) each morning. Use Benadryl at bedtime. No prescription is needed.
Cool Baths for Itching:
For flare-ups of itching, give your child a cool or lukewarm bath. Bathe for 10 minutes.
Can add baking soda 2 ounces (60 mL) per tub.
Avoid all soaps. Reason: Soaps make the itching worse.
Cut Nails for Itching:
Discourage scratching.
Cut the fingernails short. Reason: Prevents a skin infection from bacteria.
Cleaning the House:
Live scabies mites are in clothing your child has worn in the last 3 days.
Machine wash all your child's sheets, pillowcases, underwear, pajamas, and other recently worn clothing. Use hot water. High dryer temps also kill mites.
Put items that can't be washed (such as blankets) into plastic bags. You need to keep them in the bags for 4 days to kill the mites. Scabies cannot live off the human skin for more than 3 days.
What to Expect:
One treatment with a prescription anti-scabies cream usually helps. This usually kills all the scabies mites and eggs. Make sure you leave it on for 8-12 hours.
The rash will heal up and go away in 2 weeks. There shouldn't be any new rash after treatment.
The itching may last up to 4 weeks. Reason: It's an allergic reaction to the dead scabies.
Return to School:
Your child can return 24 hours after one treatment with the anti-scabies cream.
Call Your Doctor If:
Rash looks infected (draining pus, scabs become larger)
Itching becomes worse or lasts over 4 weeks
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Sting from a scorpion
Onset of local pain and tingling after a scorpion is seen in the area
The main symptoms are pain, tingling and numbness at the sting site
Scorpions
Scorpions look like tiny lobsters in front. In back, they have a long tail with a stinger at the end. It curls up and over their bodies. They have 8 legs, like spiders.
Venom: The stinger has venom. The venom causes pain and other symptoms when it is shot into the skin.
Size: average size is 3 inches (7.5 cm). Range in size from 1 - 7 inches (2.5 to 18 cm).
Scorpions are most active at night. They like dark and moist places.
There are about 40 types of scorpions in the US.
All scorpions can sting, causing pain, tingling, and numbness at the sting site. Note: Some stings do not inject venom.
The only US scorpion that can cause serious symptoms is the bark scorpion. See below.
Children and older adults are more likely to have severe symptoms. People with chronic medical problems are also at higher risk.
Bark Scorpion
The only US scorpion that can cause serious symptoms is the bark scorpion.
Color: bark scorpions are yellow-brown (tan) or orange in color.
Size: 2-3 inches long (5-7.5 cm)
They are found mostly in Arizona. Also can be found in New Mexico, Nevada, California, and Texas. They also live in Mexico, Central America, and the Caribbean.
Deaths in the US from a scorpion sting are rare.
Note: Most people cannot tell a bark scorpion from a harmless scorpion. Catching or saving the scorpion to show your doctor is not helpful. Treatment is based on symptoms. Just kill the intruder.
Types of Reactions for Bark Scorpion Stings
About 85% cause only local symptoms at the sting site.
About 10% cause painful shock waves in the same arm or leg as the sting.
Less than 5% cause any serious symptoms.
Mild Symptoms of a Scorpion Sting
All scorpion stings cause pain, tingling, and numbness at the sting site.
Pain starts right away. The pain can be severe for the first 2 hours. Symptoms around the site start to go away over the next 24 hours.
There is often no swelling or redness of the sting.
About 10% of stings also cause waves of tingling. The tingling travels up the stung arm or leg. It feels like an electric shock.
Most scorpion stings do not need to be seen.
Serious Symptoms of a Scorpion Sting
Most people will not get any serious symptoms. If they do occur, they will start in the first 2-3 hours after the sting. First signs of a serious sting can be muscle twitching or rapid eye movements. Pain, tingling and numbness can also spread to all the arms and legs. Other serious symptoms include:
Trouble swallowing
Trouble breathing
Blurry eyesight
Roving or jerky eye movements
Slurred speech
Muscle twitching
Expert Reviewers:
Anne-Michelle Ruha, MD, and Min Kang, MD, pediatric toxicologists
When To Call
Call 911 Now
Passed out or too weak to stand
Trouble breathing or wheezing
Drooling or trouble swallowing
Seizure or muscle jerking
Hives or swelling all over the body
You think your child has a life-threatening emergency
Go to ER Now
Jerky eye movements or vision problems
Mild muscle twitching
Child is restless (can't sit still)
Child crying and can't be comforted
Call Poison Center Now
Any symptoms occur in other parts of the body. Note: symptoms that only spread up the stung arm or leg are safe.
Age less than 2 years
Sting caused by known bark scorpion
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Spreading redness that started more than 24 hours after the sting
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Last tetanus shot was more than 10 years ago
You have other questions or concerns
Self Care at Home
Minor scorpion sting with symptoms only around the sting
Waves of tingling and pain only up the arm or leg with the sting
Preventing scorpion stings
Care Advice
Scorpion Sting Treatment
What You Should Know about Scorpion Stings:
The main symptoms are pain, tingling and numbness only in the sting area.
Symptoms shouldn't be any worse than a bad bee sting.
Sometimes, the arm or leg with the sting gets waves of tingling and pain.
Here is some care advice that should help.
Clean the Sting Site:
Wash the sting site well with soap and water.
Cold Pack for Pain:
For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
Put it on the sting for 20 minutes.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Treatment of Painful Shock Waves up the Arm or Leg:
Until they go away, keep using the pain medicine as needed.
Also, try to avoid bumping that arm or leg.
What to Expect:
Pain at the sting site is usually gone by 24 hours.
Shock waves of tingling also gone by 24 hours.
Numbness and tingling around the sting may last 2 to 3 days.
Call Your Doctor If:
Serious symptoms occur
Pain, tingling or numbness start on both sides of the body
Sting starts to look infected
You think your child needs to be seen
Your child becomes worse
Prevent Scorpion Stings
Prevent Scorpion Stings:
Do not walk barefoot in the desert, especially at night. Scorpions are most active at night.
Check your shoes before you put them on (shake them).
Shake out clothes, towels, bedding, and sleeping bags before using.
Roll back your sheets at night, before getting into bed.
Prevent Scorpions Around Your Home:
Clear away any piles of wood or debris that are near the house. Scorpions hide there.
Weatherstrip your windows and doors.
Place the legs of a baby's crib in wide-mouthed glass jars. Scorpions can't climb glass.
Hire a pest control expert for repeated problems.
Call Your Doctor If:
You have more questions
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Injuries to the skin anywhere on the body surface
Includes cuts, scratches, scrapes, bruises and swelling
Types of Skin Injury
Cuts, lacerations, gashes and tears. These are wounds that go through the skin to the fat tissue. Caused by a sharp object.
Scrapes, abrasions, scratches and floor burns. These are surface wounds that don't go all the way through the skin. Scrapes are common on the knees, elbows and palms.
Bruises. These are bleeding into the skin from damaged blood vessels. Caused by a blunt object. They can occur without a cut or scrape.
When Sutures (Stitches) are Needed for Cuts
Any cut that is split open or gaping needs sutures.
Cuts longer than ½ inch (12 mm) usually need sutures.
On the face, cuts longer than ¼ inch (6 mm) usually need to be seen. They usually need closure with sutures or skin glue.
Any open wound that may need sutures should be seen as soon as possible. Ideally, they should be checked and closed within 6 hours. Reason: to prevent wound infections. There is no cutoff, however, for treating open wounds.
Cuts Versus Scratches: Helping You Decide
The skin is about 1/8 inch (3 mm) thick.
A cut (laceration) goes through it.
A scratch or scrape (wide scratch) doesn't go through the skin.
Cuts that gape open at rest or with movement need stitches to prevent scarring.
Scrapes and scratches never need stitches, no matter how long they are.
So this distinction is important.
When To Call
Call 911 Now
Major bleeding that can't be stopped
Deep cut to chest, stomach, head or neck (such as with a knife)
Go to ER Now
Bleeding that won't stop after 10 minutes of direct pressure
Cut or scrape is very deep (can see bone or tendons)
Large deep cut that will need many stitches
Call Doctor or Seek Care Now
Skin is split open or gaping and may need stitches
Severe pain and not better 2 hours after taking pain medicine
Age less than 1 year old
Dirt in the wound is not gone after 15 minutes of scrubbing
Skin loss from bad scrape goes very deep
Bad scrape covers large area
Cut or scrape looks infected (redness, red streak or pus)
Cut or scrape and no past tetanus shots
You think your child has a serious injury
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Very large bruise after a minor injury
Some bruises appear without any known injury
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Dirty cut and no tetanus shot in more than 5 years
Clean cut and no tetanus shot in more than 10 years
Doesn't heal by 10 days
You have other questions or concerns
Self Care at Home
Minor cut, scrape or bruise (minor bleeding that stops)
Care Advice
Cuts, Scratches and Scrapes - Treatment:
Use direct pressure to stop any bleeding. Do this for 10 minutes or until the bleeding stops.
Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water.
Caution: Never soak a wound that might need sutures. Reason: It may become more swollen and harder to close.
Gently scrub out any dirt with a washcloth.
Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover it with a bandage (such as Band-Aid). Change daily.
Liquid Skin Bandage for Minor Cuts and Scrapes:
Liquid skin bandage seals wounds with a plastic coating. It lasts up to 1 week.
Liquid skin bandage has several benefits compared to other bandages (such as Band-Aid). Liquid bandage only needs to be put on once. It seals the wound and may promote faster healing and lower infection rates. Also, it's water-proof.
Wash and dry the wound first. Then, put on the liquid. It comes with a brush or swab. It dries in less than a minute.
You can get this product at a drugstore near you. There are many brands of liquid bandage. No prescription is needed.
Bruises - Treatment:
Use a cold pack or ice bag wrapped in a wet cloth. Put it on the bruise once for 20 minutes. This will help to stop the bleeding.
After 48 hours, use a warm wet wash cloth. Do this for 10 minutes 3 times per day. This helps to reabsorb the blood.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Tetanus Shot:
A tetanus shot update may be needed for cuts and other open wounds.
Check your vaccine records to see when your child got the last one.
For Dirty Cuts and Scrapes. If last tetanus shot was given over 5 years ago, need a booster.
For Clean Cuts. If last tetanus shot was given over 10 years ago, need a booster.
See your child's doctor for a booster during regular office hours. It's safe to give it within 3 days or less.
What to Expect:
Small cuts and scrapes heal up in less than a week.
Call Your Doctor If:
Bleeding does not stop after using direct pressure to the cut
Starts to look infected (pus, redness)
Doesn't heal by 10 days
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A foreign object stuck in the skin
Some examples are a wood splinter, fishhook, glass sliver or needle
Symptoms of a Foreign Object in the Skin
Pain. Most tiny slivers in the top layer of skin do not cause much pain. An example of these tiny slivers is plant stickers. Objects that are deeper or go straight down are usually painful to pressure. Objects in the foot are very painful with standing or walking.
Foreign Object Sensation. Older children may complain about something being in the skin. ("I feel something in there.")
Types of Foreign Bodies (Objects)
Wood (Organic): splinters, cactus spines, thorns, toothpicks. These objects are irritating and become infected if not removed.
Metallic: BBs, nails, sewing needles, pins, tacks
Fiberglass slivers
Fishhooks may have a barbed point that makes removal difficult
Glass sliver
Pencil lead (graphite, not lead)
Plastic sliver
When To Call
Go to ER Now
Object is deep in the skin (such as a needle or toothpick in the foot)
Call Doctor or Seek Care Now
Object has a barb (such as a fish hook)
Object is a BB
Object is causing severe pain
You want a doctor to take out the object
You tried and can't get the object out
Wound looks infected (spreading redness)
Fever occurs
You think your child has a serious injury
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Deep puncture wound and last tetanus shot was more than 5 years ago
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Tiny, pain-free slivers near the surface that don't need to be removed
Tiny plant or cactus spines or fiberglass slivers that need to be removed
Minor sliver, splinter or thorn that needs removal. You think you can do it at home.
Care Advice
Tiny, Pain-Free Slivers - Treatment:
Tiny, pain-free slivers near the skin surface can be left in.
They will slowly work their way out with normal shedding of the skin.
Sometimes, the body also will reject them by forming a little pimple. This will drain on its own. Or you can open up the pimple. Use a clean needle. The sliver will flow out with the pus.
Tiny Painful Plant Stickers - Treatment:
Plant stickers or cactus spines are hard to remove. Fiberglass slivers may also be hard to get out. Reason: They are fragile. Most often, they break when pressure is applied with a tweezers.
Tape. First, try touching the spot lightly with tape. The stickers should attach to the tape. You can use packaging tape, duct tape or another very sticky tape.
Wax Hair Remover. If tape doesn't work, use wax hair remover. Put a thin layer on. Let it air dry for 5 minutes. You can also speed up the process with a hair dryer. Then peel it off with the stickers. Most will be removed. The others will usually work themselves out with normal shedding of the skin.
Needle and Tweezers for Slivers and Splinters:
For larger splinters, slivers or thorns, remove with a needle and tweezers.
Check the tweezers first. Be certain the ends (pickups) meet exactly. If they do not, bend them. Clean the tool with rubbing alcohol before using them.
Clean the skin around the sliver briefly with rubbing alcohol. Do this before trying to remove it. If you don't have any, use soap and water. Caution: Don't soak the spot if the foreign object is wood. Reason: can cause swelling of the splinter.
Use the needle to uncover the large end of the sliver. Use good lighting. A magnifying glass may help.
Grasp the end firmly with the tweezers. Pull it out at the same angle that it went in. Get a good grip the first time. This is important for slivers that go straight into the skin. This is also important for those trapped under the fingernail.
For slivers under a fingernail, sometimes part of the nail must be cut away. Use a fine scissors to expose the end of the sliver.
Slivers (where you can see all of it) often can be removed at home. Pull on the end. If the end breaks off, open the skin with a sterile needle. Go along the length of the sliver and flick it out.
Antibiotic Ointment:
Wash the area with soap and water before and after removal.
Use an antibiotic ointment (such as Polysporin) once after sliver is taken out. No prescription is needed. This will help to decrease the risk of infection.
Call Your Doctor If:
You can't get the object out
Object is out, but pain gets worse
Starts to look infected
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Injuries to the skin anywhere on the body surface
Includes cuts, scratches, scrapes, bruises and swelling
Types of Skin Injury
Cuts, lacerations, gashes and tears. These are wounds that go through the skin to the fat tissue. Caused by a sharp object.
Scrapes, abrasions, scratches and floor burns. These are surface wounds that don't go all the way through the skin. Scrapes are common on the knees, elbows and palms.
Bruises. These are bleeding into the skin from damaged blood vessels. Caused by a blunt object. They can occur without a cut or scrape.
When Sutures (Stitches) are Needed for Cuts
Any cut that is split open or gaping needs sutures.
Cuts longer than ½ inch (12 mm) usually need sutures.
On the face, cuts longer than ¼ inch (6 mm) usually need to be seen. They usually need closure with sutures or skin glue.
Any open wound that may need sutures should be seen as soon as possible. Ideally, they should be checked and closed within 6 hours. Reason: to prevent wound infections. There is no cutoff, however, for treating open wounds.
Cuts Versus Scratches: Helping You Decide
The skin is about 1/8 inch (3 mm) thick.
A cut (laceration) goes through it.
A scratch or scrape (wide scratch) doesn't go through the skin.
Cuts that gape open at rest or with movement need stitches to prevent scarring.
Scrapes and scratches never need stitches, no matter how long they are.
So this distinction is important.
When To Call
Call 911 Now
Major bleeding that can't be stopped
Deep cut to chest, stomach, head or neck (such as with a knife)
Go to ER Now
Bleeding that won't stop after 10 minutes of direct pressure
Cut or scrape is very deep (can see bone or tendons)
Large deep cut that will need many stitches
Call Doctor or Seek Care Now
Skin is split open or gaping and may need stitches
Severe pain and not better 2 hours after taking pain medicine
Age less than 1 year old
Dirt in the wound is not gone after 15 minutes of scrubbing
Skin loss from bad scrape goes very deep
Bad scrape covers large area
Cut or scrape looks infected (redness, red streak or pus)
Cut or scrape and no past tetanus shots
You think your child has a serious injury
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Very large bruise after a minor injury
Some bruises appear without any known injury
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Dirty cut and no tetanus shot in more than 5 years
Clean cut and no tetanus shot in more than 10 years
Doesn't heal by 10 days
You have other questions or concerns
Self Care at Home
Minor cut, scrape or bruise (minor bleeding that stops)
Care Advice
Cuts, Scratches and Scrapes - Treatment:
Use direct pressure to stop any bleeding. Do this for 10 minutes or until the bleeding stops.
Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water.
Caution: Never soak a wound that might need sutures. Reason: It may become more swollen and harder to close.
Gently scrub out any dirt with a washcloth.
Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover it with a bandage (such as Band-Aid). Change daily.
Liquid Skin Bandage for Minor Cuts and Scrapes:
Liquid skin bandage seals wounds with a plastic coating. It lasts up to 1 week.
Liquid skin bandage has several benefits compared to other bandages (such as Band-Aid). Liquid bandage only needs to be put on once. It seals the wound and may promote faster healing and lower infection rates. Also, it's water-proof.
Wash and dry the wound first. Then, put on the liquid. It comes with a brush or swab. It dries in less than a minute.
You can get this product at a drugstore near you. There are many brands of liquid bandage. No prescription is needed.
Bruises - Treatment:
Use a cold pack or ice bag wrapped in a wet cloth. Put it on the bruise once for 20 minutes. This will help to stop the bleeding.
After 48 hours, use a warm wet wash cloth. Do this for 10 minutes 3 times per day. This helps to reabsorb the blood.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Tetanus Shot:
A tetanus shot update may be needed for cuts and other open wounds.
Check your vaccine records to see when your child got the last one.
For Dirty Cuts and Scrapes. If last tetanus shot was given over 5 years ago, need a booster.
For Clean Cuts. If last tetanus shot was given over 10 years ago, need a booster.
See your child's doctor for a booster during regular office hours. It's safe to give it within 3 days or less.
What to Expect:
Small cuts and scrapes heal up in less than a week.
Call Your Doctor If:
Bleeding does not stop after using direct pressure to the cut
Starts to look infected (pus, redness)
Doesn't heal by 10 days
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A skin lump or bump covered by normal skin
Skin swelling just in one spot (localized) is also included
Causes of Skin Lumps
Insect Bites. The most common cause of an itchy bump is a mosquito bite. Other insects can also cause little bumps.
Stings. A bee sting can cause a painful bump. The swelling can become quite large.
Lymph Nodes. Most common cause of a lump or mass felt under the skin. Commonly found in the neck or groin. Nodes have a boundary or edge and are movable. This is not the case for the swelling seen with insect bites. Lymph nodes become larger with infections.
Scalp Hematoma. The most common cause of a lump on the head is a scalp hematoma (goose egg). In a child under 2 years of age the injury may not have been seen.
Injuries. New lumps anywhere can be caused by an injury that wasn't observed. A bruise is often present with the swelling.
Callus. Broken bones heal with new bone formation. The medical term is callus. The callus feels like a bony knot that is larger than the bone itself. A callus is most commonly felt after a collarbone fracture.
Boils. A boil is a skin abscess. It causes a very painful red lump.
Lumps that are a Normal Part of the Body
Breast Bud. A small disc-shaped lump felt under the nipple. It indicates the onset of puberty in 7-12 year old girls.
External Occipital Protuberance. The bony lump felt at the base of the skull in back.
Mastoid Process. The bony lump felt behind each lower ear.
Xiphoid Process. A small hard lump felt at the lower end of the sternum (breastbone).
Common Objects Used to Guess the Size
Pea or pencil eraser: ¼ inch or 6 mm
Dime: ¾ inch or 1.8 cm
Quarter: 1 inch or 2.5 cm
Golf ball: 1 ½ inches or 3.8 cm
Tennis Ball: 2 ½ inches or 6.4 cm
Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.
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When To Call
Call Doctor or Seek Care Now
Redness spreading from the lump with fever
Groin swelling and painful
Age less than 12 months and on scalp. Exception: normal bump in back at base of skull.
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Redness spreading from the lump without fever
Boil suspected (painful, non-itchy, red lump)
Age 12 months or older and on scalp. Exception: normal bump in back at base of skull.
Can't move nearest joint normally (bend and straighten completely)
Swelling is painful and cause not known
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Large lump more than 1 inch (2.5 cm) and cause not known
Small lump lasts more than 7 days and cause not known
You have other questions or concerns
Self Care at Home
Small lump present 7 days or less and cause not known. Reasonprobably due to insect bite not observed.
Breast bud - normal lump under the nipple
External occipital protuberance - normal lump on back of head
Mastoid process - normal lump behind each lower ear
Xiphoid process - normal lump at bottom of breastbone
Care Advice
Treatment for a Small Lump or Swelling
What You Should Know:
Most new swellings are due to insect bites. Mosquito bites account for 90% of them. Your child may not even know that he got bit.
Suspect an insect bite if there are bites on other parts of the body.
While most insect bites cause a small red bump, some are larger (like a hive).
This does not mean your child has an allergy or the bite is infected.
Here is some care advice that should help.
Cold Pack for Swelling:
Apply a cold pack or cold wet washcloth for 20 minutes.
Steroid Cream for Itching:
If the swelling is itchy, use 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
Do this 3 times per day.
Allergy Medicine for Itching or Swelling:
For severe itch or swelling, give an allergy medicine by mouth. No prescription is needed.
Benadryl is best. Repeat every 6 hours as needed.
If you only have another allergy medicine at home (but not Benadryl), use that. Follow the package directions.
What to Expect:
Most insect bites itch or hurt for 1 or 2 days.
The swelling usually peaks in 2 days, but may last a week.
If the swelling becomes larger or doesn't go away, it needs to be examined.
Call Your Doctor If:
Swelling becomes very painful
Fever occurs
Swelling becomes large (over 1 inch or 2.5 cm)
Swelling lasts over 7 days
You think your child needs to be seen
Your child becomes worse
Lumps that are a Normal Part of the Body
Breast Buds - Normal Lump Under the Nipple:
Breast buds are normal, small disc-shaped rubbery lumps felt under the nipple.
Age. They normally occur in 8-12 year old girls and are the first sign of puberty. Sometimes, they are even normal in 7 year olds.
One Side. They sometimes start just on one side. Don't worry about that. Within 2 or 3 months, a breast bud will also appear on the other side.
Importance. The entire breast develops entirely from the breast bud, taking 2 or 3 years to completion.
Symptoms. Breast buds normally can be somewhat tender.
Caution: Never squeeze or massage breast buds. Reason: Can cause a serious infection.
Risks. None. Breast buds have no risk of turning into cancer.
Follow-up. You can have your child's doctor check the breast bud during the next regular office visit.
External Occipital Protuberance - Normal Lump on Back of Head:
The lump you feel at the base of the skull in back is normal. It is a bony part of the skull that sticks out and feels hard.
If you feel carefully, you will find one on yourself or other children.
This is not caused by any injury.
Mastoid Process - Normal Lump Behind the Ear:
The mastoid process is a bony lump you can feel behind the lower ear.
Muscles that turn the neck attach to the mastoid process.
The process is larger in men because of larger neck muscles.
The mastoid is filled with air cells that connect to the inner ear.
Xiphoid Process - Normal Lump at Bottom of Breastbone:
The small hard lump at the lower end of the sternum (breastbone) is normal. It is called the xiphoid process. You can feel it.
It is more prominent in babies and slender children. Sometimes, it's more visible when breathing in.
If you feel carefully, you will find one on yourself or other children.
It's made of cartilage, but turns to bone in adults.
Call Your Doctor If:
You have other questions or concerns
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A foreign object stuck in the skin
Some examples are a wood splinter, fishhook, glass sliver or needle
Symptoms of a Foreign Object in the Skin
Pain. Most tiny slivers in the top layer of skin do not cause much pain. An example of these tiny slivers is plant stickers. Objects that are deeper or go straight down are usually painful to pressure. Objects in the foot are very painful with standing or walking.
Foreign Object Sensation. Older children may complain about something being in the skin. ("I feel something in there.")
Types of Foreign Bodies (Objects)
Wood (Organic): splinters, cactus spines, thorns, toothpicks. These objects are irritating and become infected if not removed.
Metallic: BBs, nails, sewing needles, pins, tacks
Fiberglass slivers
Fishhooks may have a barbed point that makes removal difficult
Glass sliver
Pencil lead (graphite, not lead)
Plastic sliver
When To Call
Go to ER Now
Object is deep in the skin (such as a needle or toothpick in the foot)
Call Doctor or Seek Care Now
Object has a barb (such as a fish hook)
Object is a BB
Object is causing severe pain
You want a doctor to take out the object
You tried and can't get the object out
Wound looks infected (spreading redness)
Fever occurs
You think your child has a serious injury
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Deep puncture wound and last tetanus shot was more than 5 years ago
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Tiny, pain-free slivers near the surface that don't need to be removed
Tiny plant or cactus spines or fiberglass slivers that need to be removed
Minor sliver, splinter or thorn that needs removal. You think you can do it at home.
Care Advice
Tiny, Pain-Free Slivers - Treatment:
Tiny, pain-free slivers near the skin surface can be left in.
They will slowly work their way out with normal shedding of the skin.
Sometimes, the body also will reject them by forming a little pimple. This will drain on its own. Or you can open up the pimple. Use a clean needle. The sliver will flow out with the pus.
Tiny Painful Plant Stickers - Treatment:
Plant stickers or cactus spines are hard to remove. Fiberglass slivers may also be hard to get out. Reason: They are fragile. Most often, they break when pressure is applied with a tweezers.
Tape. First, try touching the spot lightly with tape. The stickers should attach to the tape. You can use packaging tape, duct tape or another very sticky tape.
Wax Hair Remover. If tape doesn't work, use wax hair remover. Put a thin layer on. Let it air dry for 5 minutes. You can also speed up the process with a hair dryer. Then peel it off with the stickers. Most will be removed. The others will usually work themselves out with normal shedding of the skin.
Needle and Tweezers for Slivers and Splinters:
For larger splinters, slivers or thorns, remove with a needle and tweezers.
Check the tweezers first. Be certain the ends (pickups) meet exactly. If they do not, bend them. Clean the tool with rubbing alcohol before using them.
Clean the skin around the sliver briefly with rubbing alcohol. Do this before trying to remove it. If you don't have any, use soap and water. Caution: Don't soak the spot if the foreign object is wood. Reason: can cause swelling of the splinter.
Use the needle to uncover the large end of the sliver. Use good lighting. A magnifying glass may help.
Grasp the end firmly with the tweezers. Pull it out at the same angle that it went in. Get a good grip the first time. This is important for slivers that go straight into the skin. This is also important for those trapped under the fingernail.
For slivers under a fingernail, sometimes part of the nail must be cut away. Use a fine scissors to expose the end of the sliver.
Slivers (where you can see all of it) often can be removed at home. Pull on the end. If the end breaks off, open the skin with a sterile needle. Go along the length of the sliver and flick it out.
Antibiotic Ointment:
Wash the area with soap and water before and after removal.
Use an antibiotic ointment (such as Polysporin) once after sliver is taken out. No prescription is needed. This will help to decrease the risk of infection.
Call Your Doctor If:
You can't get the object out
Object is out, but pain gets worse
Starts to look infected
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Bite from a spider
Symptoms of a Spider Bite
Most spider bites cause local pain, redness and swelling. It's much like a bee sting reaction.
A few spiders (such as the Black Widow) can cause a more severe reaction.
Helpful if spider seen on the skin or around the child
Cause of Spider Bite Reactions
Most spiders have tiny fangs. They inject venom into the skin.
The venom is what causes all the symptoms.
Types of Spider Bites
Black Widow Spider Bite
A shiny, jet-black spider with long legs (total size 1 inch or 25 mm).
A red (or orange) hourglass-shaped marking on its under-side.
Causes immediate local pain and swelling.
Sometimes, you can see 2 fang marks at the bite site.
Severe muscle cramps (especially stomach cramps) occur within 1 to 6 hours. These last 24 to 48 hours.
Rarely causes death. Exception: bitten by several spiders or small child is bitten.
Note: many are dry bites because the fangs are small.
The brown widow spider is related to the black widow. It is found in southern US.
Brown widow spider bites are treated the same as black widow bites.
Brown Recluse Spider Bite
A brown spider with long legs (total size ½ inch or 12 mm).
A dark violin shaped marking on top of its head.
Causes pain at the bite. Blisters form within 4 to 8 hours.
The center becomes bluish and depressed (crater-like) over 2 to 3 days.
Skin damage may require skin grafting in 10% of cases.
Other symptoms such as fever, vomiting, muscle pain can occur. No life-threatening symptoms occur.
Brown recluse spiders are hard to identify. If you can, bring the spider along in a jar.
Non-dangerous Spider Bites
More than 50 spiders in the U.S. have venom. Their bites cause reactions that are not serious. This includes pain or redness at the bite site.
The bites are painful and swollen. This lasts for 1 or 2 days. They can feel and look like a bee sting.
Some single, unexplained, tender bites that occur during the night are due to spiders.
When To Call
Call 911 Now
Trouble breathing or wheezing
Passed out (fainted) or too weak to stand
You think your child has a life-threatening emergency
Go to ER Now
Black or brown widow spider bite suspected
Stomach pain, chest tightness or other muscle cramps
Bite pain is severe and not improved after using care advice
Call Doctor or Seek Care Now
Fever and bite looks infected (spreading redness)
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
New redness starts more than 24 hours after the bite. Note: any redness in the first 24 hours is due to venom.
More than 48 hours since the bite and redness now getting larger
Bite starts to look bad (such as skin damage, blister or purple color)
Bite pain lasts more than 2 days
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Non-serious spider bite
Care Advice
What You Should Know About Spider Bites:
Most spider bites look and feel like a bee sting.
The main symptoms are pain and redness.
Here is some care advice that should help.
Clean the Bite:
Wash the bite well with soap and water.
Cold Pack for Pain:
For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
Put it on the bite for 20 minutes.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
What to Expect:
The swelling and pain lasts for 1 to 2 days.
It should not be any worse than a bee sting.
Call Your Doctor If:
Severe bite pain lasts more than 2 hours after pain medicine
Stomach pains or muscle cramps occur
Bite pain lasts more than 2 days (48 hours)
Bite starts to look infected
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Red or blistered skin from too much sun
The redness, pain and swelling starts at 4 hours after being in the sun
It peaks at 24 hours, and starts to get better after 48 hours
Severity of Sunburn
Most sunburn is a first-degree burn that turns the skin pink or red.
Prolonged sun exposure can cause blistering and a second-degree burn.
Sunburn never causes a third-degree burn or scarring.
Causes of Sunburn
Direct sun exposure. Warning: clouds don't help. 70% of UV light still gets through on cloudy days.
Reflected sun rays. From snow 80% is reflected, from sand 20%, from water only 5%.
Tanning lamp or sun lamp.
Tanning bed. A common cause in teens.
Ibuprofen to Reduce Pain and Other Symptoms
Sunburn is an inflammatory reaction of the skin.
Ibuprofen is a drug that can block this reaction. It can reduce the redness and swelling. But, it needs to be started early.
Sunburns are sneaky. Many parents are surprised when their child gets a sunburn. Reason: there are no warning signs while the burn is occurring.
Redness (sunburn) often is not seen until 4 hours after being in the sun. The pain and redness keep getting worse. They don't peak for 24 to 36 hours.
Lesson: if you think your child got too much sun, start ibuprofen then. Give it 3 times per day for 2 days. Don't wait for redness.
When To Call
Call 911 Now
Passed out (fainted) or too weak to stand
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Fever over 104° F (40° C)
Can't look at lights because of eye pain
Fever and looks infected (spreading redness more than 48 hours after the sunburn)
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Sunburn pain is severe and not better after using care advice
Large blisters (more than ½ inch or 12 mm)
Many small blisters at the burn site
Blisters on the face
Swollen feet make it hard to walk
Looks infected (draining pus, red streaks, worse pain after day 2) and no fever
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Itchy rashes in sun-exposed skin occur many times
You have other questions or concerns
Self Care at Home
Mild sunburn
Care Advice
Treating Mild Sunburn
What You Should Know About Sunburns:
Most sunburns do not blister.
Most blisters can be treated without needing to see a doctor.
Here is some care advice that should help.
Ibuprofen for Pain:
For pain relief, give an ibuprofen product (such as Advil). Start this as soon as you can.
Give every 6-8 hours.
Reason: If started within 6 hours, it can greatly limit the pain and swelling. Must give for 2 days.
Caution: Not approved for age under 6 months.
Steroid Cream for Pain:
Use 1% hydrocortisone cream (such as Cortaid) as soon as possible. No prescription is needed.
Put it on 3 times per day.
If used early and continued for 2 days, it may reduce swelling and pain.
Use a moisturizing cream or aloe vera cream until you can get some.
Use creams only. Avoid putting ointments on red skin. Reason: They can block the sweat glands.
Burned skin can be very painful. Covering it with a cream can give great relief.
Cool Baths for Pain:
Use cool wet washcloths to the burned area. Do this several times a day to reduce pain and burning.
For larger sunburns, give cool baths for 10 minutes. Caution: Avoid any chill. Can add 2 ounces (60 mL) baking soda per tub.
Do not use soap on the sunburn.
Fluids - Offer More:
Offer extra water on the first day.
This helps to replace the fluids lost into the sunburn.
This will also help to prevent dehydration and dizziness.
Blisters - Don't Open:
Caution: Leave closed blisters alone. Reason: To prevent infection.
For broken blisters, trim off the dead skin. Use a fine scissors cleaned with rubbing alcohol.
Antibiotic Ointment for Open Blisters:
For any large open blisters, use an antibiotic ointment (such as Polysporin). No prescription is needed.
Remove it with warm water. Then, reapply it 2 times a day for 3 days.
What to Expect:
Pain stops after 2 or 3 days.
Peeling occurs day 5-7.
Call Your Doctor If:
Pain becomes severe
Sunburn looks infected
You think your child needs to be seen
Your child becomes worse
Preventing Sunburn
Sunscreens:
Use a sunscreen with an SPF of 15 or higher. Fair-skinned children need a sunscreen with an SPF of 30. This is especially true if your child has red or blond hair.
Put sunscreen on 30 minutes before exposure to the sun. This gives it time to get down into the skin. Give special attention to the areas most likely to become sunburned. Examples are the nose, ears, cheeks, and shoulders.
Put sunscreen back on every 3 to 4 hours. Apply often while swimming or if sweating a lot. A "waterproof" sunscreen stays on for about 30 minutes in water.
Most people use too little sunscreen. The average adult requires 1 ounce (30 mL) of sunscreen at a time.
The best way to prevent skin cancer is to prevent sunburns.
Infants and Sunscreens:
The skin of infants is thinner than the skin of older children. It is more sensitive to the sun.
Sun avoidance is best for children under 6 months. Stay in the shade.
Sun avoidance or sun proof clothing are best for children 6 months to 3 years. That means clothes that fully cover the arms and legs. Also, have your child wear a hat with a brim.
When a sunscreen is needed, infants can use adult sunscreens. The FDA hasn't approved their use under 6 months old. However, the AAP supports their use at this age. There are no reported harmful side effects from today's sunscreens.
Protect Lips, Nose and Eyes:
To prevent sunburned lips, apply a lip coating that contains sunscreen.
If the nose or some other area has been burned often, protect it completely. Use zinc oxide or titanium oxide ointment.
Protect your child's eyes from the sun's rays and cataracts with good sunglasses.
High-Risk Children:
Some children are at higher risk for sunburn. If your child has red or blond hair, he is at higher risk. Fair-skinned children and children who never tan are also at higher risk.
These children need to use a sunscreen even for brief exposures.
They should avoid sun exposure whenever possible.
High-Risk Time of Day:
Avoid exposure to the sun during the hours of 11:00 AM to 3:00 PM. This is when the sun's rays are most intense.
Caution: When overcast, over 70% of the sun's rays still get through the clouds.
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Sutures or stitches questions
Stapled wounds are treated the same as sutured wounds
Skin glue (Dermabond) questions are also covered
When Sutures (Stitches) are Needed for Cuts
Any cut that is split open or gaping needs sutures.
Cuts longer than ½ inch (12 mm) usually need sutures.
On the face, cuts longer than ¼ inch (6 mm) usually need to be seen. They usually need closure with sutures or skin glue.
Any open wound that may need sutures should be seen as soon as possible. Ideally, they should be checked and closed within 6 hours. Reason: to prevent wound infections. There is no cutoff, however, for treating open wounds.
When Sutures (Stitches) Should be Removed
Stitches and staples are used to keep wounds together during healing.
They need to be removed within 4-14 days.
The specific removal date depends on the location of the stitches or staples.
Removal should not be delayed. Reason: will leave skin marks.
Wounds That Re-Open After Closure
Sutures that come out early cause the most concern.
For open cuts, call your child's doctor now. General guidelines for re-suturing or re-gluing are listed below:
Face Cuts. If a face wound has re-opened, call your doctor now. The cut may need to be re-glued or re-stitched. It does not matter how long it's been since sutures (or glue) were placed.
Body Cuts and Less Than 48 Hours. If the wound is elsewhere on the body, call your doctor now. The cut may need restitched (or glued) if gaping open. This is sometimes done if suturing was less than 48 hours ago.
Body Cuts and Over 48 Hours Ago. Call your doctor now for advice. After 48 hours, re-suturing is rarely done (except on the face). After 48 hours, the sutured wound can be reinforced with tape.
Cut Is Closed, but suture has come out early. The wound should heal up fine without any further treatment. Check with your child's doctor within the next 24 hours.
When To Call
Call 911 Now
Not moving or too weak to stand
You think your child has a life-threatening emergency
Go to ER Now
Major surgical wound that's starting to open up
Bleeding that won't stop after 10 minutes of direct pressure
Call Doctor or Seek Care Now
Stitch (or staple) came out early and wound has opened up
Wound looks infected (spreading redness, pus)
Fever occurs
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Suture came out early but wound is still closed
Suture removal is overdue
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Stitched or stapled wound with no other problems
Care Advice
Care for a Normal Sutured or Stapled Wound:
Keep sutured wounds completely dry for first 24 hours. (4 hours for Dermabond skin glue). If needed, use a sponge bath.
After 24 hours, can take brief showers.
Avoid swimming, baths or soaking the wound until sutures are removed. Avoid getting Dermabond skin glue wet until it has fallen off. Reason: Water in the wound can interfere with healing.
Use an antibiotic ointment (such as Polysporin) 3 times a day. No prescription is needed. Reason: To prevent infection and a thick scab. (Caution: Don't apply any ointments or creams to Dermabond skin glue.)
Cleanse surface with warm water once daily or if becomes dirty.
Change wound dressing when wet or dirty.
A dressing is no longer needed when edge of wound is closed. This takes about 48 hours. Exception: Dressing is needed to prevent sutures from catching on clothing.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Suture (or Staple) Removal Date. Here are some guidelines for when sutures (stitches) should be removed:
Scalp: 7-10 days (same for staples)
Face: 4-5 days
Neck: 7 days
Chest, abdomen or back: 7-10 days
Arms and back of hands: 7 days
Legs and top of feet: 10 days
Palms, soles, fingers or toes: 12-14 days
Overlying a joint: 12-14 days
Suture (or Staple) Removal Delays:
Don't miss your appointment for removing sutures.
Leaving sutures in too long can leave skin marks. Sometimes, it can cause scarring.
It also makes taking the sutures out harder.
Suture (or Staple) Out Early:
If the sutures come out early, close the wound with tape. You can also use a butterfly bandage (such as Band-Aid).
Do this until the office visit.
Wound Protection After Sutures (or Staples) Out:
Protect the wound from injury during the month after.
Avoid sports that could re-injure the wound. If a sport is essential, cover with tape before playing.
Allow the scab to fall off on its own. Do not try to pick it off. (Reason: Prevents scarring.)
Call Your Doctor If:
Starts to looks infected
Fever occurs
Sutures come out early
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
An itchy harmless rash caused by tiny parasites in fresh water lakes
Less commonly occurs in salt water (called clam digger's itch)
Symptoms of Swimmer's Itch
Itchy skin rash
Begins within 2 hours of swimming in a fresh water lake. It can also occur in salt water, although this is less common.
The rash only occurs on areas exposed to the lake water. The legs are commonly involved. The bathing suit area may be spared.
The first symptom is itching or burning of the skin.
Then small red spots appear within 1 or 2 hours. The spots appear at sites where a parasite has gotten into the skin.
The spots turn into small red lumps over 1 or 2 days.
The spots can be quite itchy for up to 7 days. The rash gradually fades away over 2 weeks.
Also called cercarial dermatitis
Cause
Swimmer's itch is caused by a very tiny parasite. (You can only see it with a microscope). It gets into the skin of humans by mistake.
The rash and itching are the body's allergic reaction to parasites in the skin.
This parasite can be found in lakes in every state (US). It is also found in lakes in Canada and over 30 other countries. In the US, Michigan and other Great Lakes region states are most involved.
It is less common in salt water (called clam digger's itch).
The parasites get into the lakes from the droppings of water birds. Their normal life cycle involves birds and snails. It dies off quickly in human skin.
Repeat Contact (Exposure) and the Body's Reaction
Swimmer's itch is the body's allergic reaction to the parasite. Each time the body is exposed, the more intense the reaction will be. This is called sensitization.
After first-time contact, the onset of itching and rash takes 1 to 2 weeks.
For repeat contact, the onset of itching and rash is within 2 hours.
The more the exposures, the faster the rash occurs. It also causes the rash and itching to become more severe.
When To Call
Call Doctor or Seek Care Now
Spreading red area or streak with fever
Spreading red area or streak that's very large
Your child looks or acts very sick
Call Doctor Within 24 Hours
Spreading red area or streak, but no fever
Severe past allergic reaction to lake swimming that needed oral steroids
You think your child needs to be seen
Call Doctor During Office Hours
Severe itching not better after 24 hours of using steroid cream
Scab that looks infected (drains pus or gets bigger). Care Advice: apply an antibiotic ointment 3 times per day until seen.
Swimmer's itch lasts more than 2 weeks
You have other questions or concerns
Self Care at Home
Swimmer's itch suspected. (Itchy rash that starts within 2 hours of being in a lake or ocean)
Care Advice
What You Should Know About Swimmer's Itch:
Swimmer's itch is caused by a small parasite found in many lakes. It is less common in salt water. The parasite normally only attacks water birds.
The main symptoms are itching and a rash.
For swimmers, the rash can be widespread.
For children who wade, the rash may occur only on the legs.
No specific medicine is needed. Reason: The parasites die once they pass into the skin. The itching is a temporary allergic reaction.
Here is some care advice that should help.
Steroid Cream for Itching:
To help with the itch, put 1% hydrocortisone cream (such as Cortaid) on the rash. No prescription is needed. Use 3 times per day.
Baking soda paste is another option. Make this by putting baking soda into a cup. Slowly, stir in water until it reaches a thickness like paste. Put it on the itchy spots as needed.
Cold Pack for Itching:
Put a cold pack on the most itchy spots. You can also use ice wrapped up in wet washcloth.
Do this for 20 minutes 4 times a day.
Allergy Medicine for Itching:
For severe itching, give an allergy medicine (such as Benadryl). Give it 4 times per day. No prescription is needed.
Caution: Do not use if age is under 1 year. Reason: Benadryl is a sedative. Give your doctor a call for advice.
Try Not to Scratch:
Help your child not to scratch.
Cut the fingernails short.
Reason: Prevents a skin infection from bacteria.
What to Expect:
The spots turn into small red lumps over 1 to 2 days.
The spots can be quite itchy for up to 7 days.
The rash gradually fades away over 2 weeks.
Return to School:
The rash cannot be spread to others.
Prevention of Swimmer's Itch:
Avoid swimming in areas where swimmer's itch has been a known problem.
Towel yourself dry right after swimming or wading. Reason: Wipe off parasites before they get under the skin.
The rash is usually worse with each exposure. So, it's very important to try to prevent recurrences.
Call Your Doctor If:
Rash becomes infected
Itching becomes severe
Rash lasts over 2 weeks
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
A tick (small brown bug) is attached to the skin
A tick was removed from the skin
Symptoms of a Tick Bite
A tick bite does not cause pain or itch. So, ticks may not be noticed for a few days.
After feeding on blood, ticks get swollen and easier to see.
Ticks fall off on their own after sucking blood for 3 to 6 days.
After the tick comes off, a little red bump may be seen.
The red bump or spot is the body's response to the tick's saliva (spit).
While it's sucking blood, some of its spit gets mixed in.
Causes of Tick Bites
The wood tick (dog tick) is the size of an apple seed. After feeding, it can double or triple in size. Sometimes, it can pass on Rocky Mountain spotted fever or Colorado tick fever.
The deer tick is the size of a poppy seed. After a feeding, it can triple in size. Sometimes, it can pass on Lyme disease.
Lyme Disease
Over 95% of people who get Lyme disease live in or have traveled to 14 high-risk states. Lyme disease mainly occurs in the Northeast, Mid-Atlantic and upper Midwest. Many states do not have Lyme disease. The CDC reports over 30,000 new cases per year (2015).
About 80% of Lyme disease starts with a bull's eye rash called erythema migrans. The rash starts at the site of the tick bite. It starts on the average at 7 days. It grows larger quickly, to more than 2 inches (5 cm) wide. It can become as large as 12 inches (30 cm). It lasts 2 or 3 weeks. Treatment of this rash with an antibiotic is advised. This almost always prevents the later stages of Lyme Disease. If Lyme Disease isn't treated, heart, joint and neurologic problems can occur.
Giving antibiotics after deer tick bites to prevent Lyme Disease depends on the risk. The risk is low with brief attachment. The risk is high if the deer tick was attached for longer than 36 hours. It's also higher if the tick is swollen, not flat. Ask your doctor for advice.
The risk of Lyme Disease after a deer tick bite is low. Even in high risk areas, only 2% of deer tick bites cause Lyme Disease.
When To Call
Call Doctor or Seek Care Now
Can't remove the tick after trying this care advice
Widespread rash starts 2 to 14 days after the bite
Fever or headache starts 2 to 14 days after the bite
Fever and bite looks infected (spreading redness)
Weak, droopy eyelid, droopy face or crooked smile
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Deer tick was attached for more than 36 hours
Deer tick is swollen, not flat
New redness starts more than 24 hours after the bite. Note: bacterial infection is rare. It does not start until at least 24-48 hours after the bite.
More than 48 hours since the bite and redness now getting larger
Red-ring or bull's eye rash occurs around a deer tick bite. Note: the rash of Lyme disease starts 3 to 30 days after the bite.
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
You have other questions or concerns
Self Care at Home
Wood tick bite
Deer tick bite
Preventing tick bites
Care Advice
Treating Tick Bites
What You Should Know About Wood Tick Bites:
Most wood tick bites are harmless.
The spread of disease by wood ticks is not common.
If the tick is still attached to the skin, it needs to be taken off.
Try one of the methods described below to take out the tick.
Wood Tick - How to Remove with Tweezers:
Use tweezers. Grasp the tick as close to the skin as possible (on its head).
Hold the tweezers sideways next to the top of the skin.
Pull the wood tick straight upward without twisting or crushing it.
Keep a steady pressure until the tick lets go of its grip.
If you don't have tweezers, you can use your fingers.
Other options. You can use a loop of thread around the jaws. You can also use a needle pushed between the jaws for traction. Jaws are the part of the head attached to the skin.
Not helpful: Covering the tick with petroleum jelly or nail polish doesn't work. Neither does rubbing alcohol or a soapy cotton ball. Touching the tick with a hot or cold object also doesn't work.
What You Should Know About Deer Tick Bites:
Most deer tick bites are harmless.
The spread of disease by deer ticks is not common.
Even in high risk areas, only 2% of deer tick bites cause Lyme disease.
Most people who get Lyme disease live in or have traveled to 14 high-risk states. Lyme disease mainly occurs in the Northeast and upper Midwest. Many states do not have Lyme disease.
Deer Tick - How to Remove:
If it is swollen, try to remove with a tweezers. See wood tick advice.
Tiny deer ticks need to be scraped off.
You can remove them with the edge of a credit card.
Tick's Head - When to Remove:
If the wood tick's head (mouth parts) breaks off in the skin, remove any large pieces.
Clean the skin with rubbing alcohol.
Use a clean tweezers or needle to scrape it off.
If a small piece remains, the skin will slowly heal and shed it.
Antibiotic Ointment:
After the tick is removed, wash the wound with soap and water. Also, wash your hands after you are done.
This helps to prevent catching any infections carried by the tick.
Use an antibiotic ointment (such as Polysporin). No prescription is needed.
Put it on the bite once.
What to Expect:
Most often, tick bites don't itch or hurt.
That's why they may not be noticed.
The little bump goes away in 2 days.
If the tick transferred a disease, a rash will occur. It will appear in the next 4 weeks.
Call Your Doctor If:
You tried and can't remove the tick
Fever or rash happens in the next 4 weeks
Bite starts to look infected
You think your child needs to be seen
Your child becomes worse
Prevent Tick Bites
Prevent Tick Bites:
After being outdoors in deer tick areas, check for ticks. Remove any that are attached. Also, take a shower soon after coming inside.
Tumble any clothing in a hot dryer for 10 minutes. That should kill any ticks left in the clothing.
When hiking outside where there are ticks, wear long clothing. Tuck the ends of pants into socks.
Use a bug repellent to shoes, socks and exposed skin.
Tick Repellent for Clothing - Permethrin:
Permethrin products (such as Duranon) work well to repel ticks.
Unlike DEET, these products are put on clothing instead of skin. They also can last through many washes. Use it on pant cuffs, socks and shoes. You can also put it on other outdoor items (bug netting, sleeping bags).
Do not put it on skin. Reason: Sweat changes it so it does not work.
Tick Repellent for Skin - DEET:
DEET also works well to repel ticks. It can be used on the skin not covered by clothing.
Use 20-30% DEET for children and teens (AAP). Note: 30% DEET protects for 6 hours.
DEET is approved for use in children over 2 months of age (AAP).
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
The corner of the toenail grows into the skin around it
Almost always involves the big toe (great toe)
Symptoms of an Ingrown Toenail
Toe pain from sharp corner of toenail cutting into surrounding skin.
Redness and swelling around the corner of the toenail is usually present.
The area may drain pus or yellow fluid.
The red area is very tender to touch or pressure from a shoe.
Some teens with an ingrown toenail can barely walk.
Cause of an Ingrown Toenail
The toenail is usually pushed into the skin by wearing tight shoes.
The tiny cut made by the nail allows bacteria to enter the skin. The cut then becomes infected.
The sharp corner of buried nail keeps growing. The deeper it goes, the more painful it becomes.
When To Call
Call 911 Now
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Spreading red area or streak with fever
Spreading red area or streak that's very large
Severe pain not improved 2 hours after pain medicine and antibiotic ointment
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Spreading red area or streak, but no fever
Entire toe is red and swollen
Pus pocket (yellow or green) seen in skin around toenail or under toenail. Reason: needs to be drained.
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Can't locate and free up corner of toenail
After using Care Advice more than 2 days, pus discharge not gone
After using Care Advice more than 3 days, still hard to walk
After using Care Advice more than 7 days, not improved
After using Care Advice more than 14 days, not gone
Ingrown toenails are a frequent problem
You have other questions or concerns
Self Care at Home
Minor ingrown toenail
Care Advice
What You Should Know About Ingrown Toenails:
Ingrown toenails are always painful.
Pain is caused by the sharp toenail edge cutting into the skin around it.
The pain can be stopped. Find the toenail corner and lift it out of the raw tissue.
This will allow the area to heal.
Most ingrown toenails can be treated at home. Surgery or nail removal is rarely needed.
Here is some care advice that should help.
Warm Soaks:
Soak the toe in warm water and soap for 20 minutes twice a day.
While soaking, massage the swollen part of the cuticle (skin next to the nail). Massage away from the nail.
While soaking, also try to bend the corners of the toenail upward.
Dry the toe and foot completely.
Elevate Corner of Toenail with Dental Floss:
Goal: To help the toenail corner grow over the cuticle, rather than into it.
Take a short strip of dental floss or fishing line. Try to slip it under the corner of the nail. Then, lift the nail upward. Cut off any sharp edge.
Take a small wedge of cotton from a cotton ball. Try to place the wedge under the nail corner to keep it elevated. (Sometimes this step is impossible).
Elevate the corner away from the cuticle with every soak.
Antibiotic Ointment:
After each soak, use an antibiotic ointment (such as Polysporin). Put it on the swollen part of the toe.
You can buy this ointment without a prescription.
Taking Pressure Off Toenail With a Cotton Ball:
Until it heals, try to wear sandals or go barefoot.
When your child must wear closed shoes protect the ingrown toenail as follows:
Inner Edge of Toe. If the inner edge of the big toe is involved, try this technique. Tape a cotton ball or foam pad between the lower part of the first and second toes. This will keep the upper toes from touching.
Outer Edge of Toe. If the outer edge is involved, use a cotton ball. Tape it to the outside of the lower toe.
This will keep the toenail from touching the side of the shoe.
Never wear tight, narrow, or pointed shoes.
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Prevention - Nail Trimming:
Cut your child's toenails straight across so you can see the corners. Use a nail clipper.
Do not round off corners. Keep the corners visible.
Do not cut them too short.
After baths or showers, the nails are soft. Bend the corners of the toenails upward.
Prevention - Wear Shoes That Fit:
Make sure that your child's shoes are not too narrow. Give away any pointed or tight shoes.
Tight narrow shoes are the most common cause of ingrown toenails.
Shoes should have a wide toe box. The toes should not feel cramped.
What to Expect:
With treatment, the pus should be gone in 48 hours.
Pain should be gone in 1 week.
Area should be healed up in 2 weeks.
Call Your Doctor If:
Spreading redness or fever occur
Pus pocket occurs
Not improved after 7 days
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Small raised growths that have a rough surface
Viral infection of the skin
Symptoms of Warts
Raised, round, rough-surfaced growths on the skin
Skin-colored or pink
Most commonly occur on the hands, especially the fingers
Not painful unless located on the sole of the foot (plantar wart). Also can be painful if on part of a finger used for writing.
Cause of Warts
Warts are caused by several human papilloma viruses
Different types of warts are caused by different papilloma viruses
Prevention of Spread to Others
Avoid baths or hot tubs with other children. Reason: Warts can spread in warm water.
Also, avoid sharing washcloths or towels.
Contact sports: Warts can spread to other team members. Warts should be covered or treated.
Time it takes to get warts after close contact: 3 months
When To Call
Call Doctor or Seek Care Now
Redness or red streak spreading from wart with fever
Your child looks or acts very sick
Call Doctor Within 24 Hours
Redness or red streak spreading from wart without fever
Boil suspected (painful, non-itchy, red lump)
You think your child needs to be seen
Call Doctor During Office Hours
Wart on bottom of foot (plantar wart)
Wart on face
Wart on genitals or anus
4 or more warts
Pus is draining from the wart (Apply antibiotic ointment 3 times per day until seen)
On treatment more than 2 weeks and new warts appear
On treatment more than 8 weeks and warts not gone
You have other questions or concerns
Self Care at Home
Common warts - 3 or less
Care Advice
What You Should Know About Warts:
Warts are common (10% of children).
Warts are harmless and most can be treated at home.
The sooner you treat them, the less they will spread.
Here is some care advice that should help.
Wart-Removing Acid:
Buy a wart medicine with 17% salicylic acid (such as Compound W). No prescription is needed.
Apply the acid once a day to the top of the wart. If there are many warts, treat the 3 largest ones.
Since it's an acid, avoid getting any near the eyes or mouth. Also try to keep it off the normal skin.
The acid will turn the wart into dead skin (it will turn white).
Duct Tape - Cover the Wart:
The acid will work faster if it is covered with duct tape. Do not use regular tape.
If you don't want to use an acid, use duct tape alone.
Covering warts with duct tape can irritate the warts. This will turn on the body's immune system.
Cover as many of the warts as possible. Cover at least 3 of them.
The covered warts become red and start to die. Once this happens, often all the warts will go away.
Try to keep the warts covered all the time.
Remove the tape once per day, usually before bathing. Then replace it after bathing.
Some children object to having the tape on at school. At the very least, tape it every night.
Remove Dead Wart:
Once or twice a week, remove the dead wart material. Do this by paring it down with a disposable razor.
This is easier to do than you think. It shouldn't cause any pain or bleeding.
Soak the area first in warm water for 10 minutes. Reason: The dead wart will be easier to remove.
Some children won't want you to cut off the layer of dead wart. Rub it off with a washcloth instead.
Prevention of Spread to Other Areas of Your Child's Body:
Discourage your child from picking at the wart. Picking it and scratching a new area with the same finger can spread warts. A new wart can form in 1 to 2 months.
Chewing or sucking on them can lead to similar warts on the face.
If your child is doing this, cover the wart. Use a bandage (such as Band-Aid).
Keep your child's fingernails cut short and wash your child's hands more often.
What to Expect:
Without treatment, warts go away in about 2 years.
With home treatment, they can usually be cleared up in 2 to 3 months.
There are no shortcuts to treating warts.
Return to School:
Your child doesn't have to miss any child care or school for warts.
There is only a mild risk that warts spread to others.
Call Your Doctor If:
Warts develop on the feet, genitals, or face
New warts develop after 2 weeks of treatment
Warts are still present after 12 weeks of treatment
You think your child needs to be seen
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Definition
Signs of wound infection include pus, spreading redness, increased pain or swelling, and fever
A break in the skin (a wound) shows signs of infection
Includes infected cuts, scrapes, sutured wounds, puncture wounds and animal bites
Most dirty wounds become infected 24 to 72 hours later
Symptoms of Wound Infections
Pus. Pus or cloudy fluid is draining from the wound.
Pimple. A pimple or yellow crust has formed on the wound.
Soft Scab. The scab has increased in size.
Red Area. Increasing redness occurs around the wound.
Red Streak. A red streak is spreading from the wound toward the heart.
More Pain. The wound has become very tender.
More Swelling. Pain or swelling is increasing 48 hours after the wound occurred.
Swollen Node. The lymph node draining that area of skin may become large and tender.
Fever. A fever occurs.
The wound hasn't healed within 10 days after the injury.
When To Call
Call 911 Now
Not moving or too weak to stand
You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
Fever occurs
Red streak runs from the wound
Spreading redness around the wound
Severe pain in the wound
Any face wound with signs of infection
No past tetanus shots
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Pus or cloudy drainage from the wound
Wound gets more painful or tender after 2 days
Last tetanus shot was more than 5 years ago
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Pimple where a stitch (or staple) comes through the skin
You have other questions or concerns
Self Care at Home
Mild redness of wound
Care Advice
What You Should Know About Normal Healing:
Some pink or red skin on the edge of the wound is normal.
It's more common if the wound is sutured.
It's also normal for it to be swollen for a few days.
Your child's wound is not infected unless the redness spreads or pain increases.
Here is some care advice that should help.
Warm Soaks or Warm Wet Cloth:
For any redness or other signs of early infection, use heat.
Open Cuts or Scrapes. Soak it in warm water. You can also put a warm wet cloth on the wound. Do this for 10 minutes 3 times per day. Use a warm saltwater solution. You can make your own. Put 2 teaspoons (10 mL) of table salt in a quart (liter) of warm water.
Closed or Sutured Cuts. Put a heating pad on the wound. You can also use a warm, moist washcloth. Do this for 10 minutes 3 times per day.
Cautions for Sutured Wounds. Do not put anything wet on the wound for first 24 hours. After 24 hours, can take brief showers. Never soak the wound before all sutures are removed.
Antibiotic Ointment:
Use an antibiotic ointment (such as Polysporin).
No prescription is needed.
Put it on the wound 3 times a day.
If the area could become dirty, cover with a bandage (such as Band-Aid).
Pain Medicine:
To help with the pain, give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Use as needed.
Fever Medicine:
For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
Another choice is an ibuprofen product (such as Advil).
Note: Fevers less than 102° F (39° C) are important for fighting infections.
For all fevers: Keep your child well hydrated. Give lots of cold fluids.
What to Expect:
Pain and swelling normally peak on day 2.
Any redness should go away by day 4.
Complete healing should occur by day 10.
Return to School:
For true wound infections, your child can return after the fever is gone. Your child should also be taking an antibiotic by mouth for 24 hours.
For minor redness around the wound, your child does not need to stay home.
Call Your Doctor If:
Wound becomes more painful
Redness starts to spread
Pus or fever occurs
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
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