Social media fueled magazine for Washington D.C. Suburbs

Dear Pediatric Guru, My son has been scratching his head and we found countless small white dots attached to his hair. Help!

What you discovered are nits (egg cases) from lice that have already hatched. These highly contagious critters transfer easily from one person to another. I usually recommend that they try the over the counter head lice shampoos first. The nits are usually cemented on strongly, but can be loosened with either lemon juice or vinegar…

Hulya Aksu: My 3 year old, in the midst of a balancing act on my thigh, slipped and hit the side of her head (right behind her ear) on the side of a metal end table yesterday. The sound, the sight... I nearly fainted. I took her in my arms and looked at the damage. Her head was literally caved in with the impression of the table. The back of her ear! I hear that is one of the most dangerous places. We put ice and did the traditional dance of "hey look out the window", "watch the cat", "who is that in the back yard" to distract her. She cried and cried and still ate the walnut she was working on during the fall.

Well when the silence kicked in, I went online to look at what I should be looking for. Good info. Scary info. Terrifying info! I stopped myself and decided to evaluate the damage myself. Made her follow my finger, whispered things in her ear to make sure nothing happened to her ear, made her walk on her tippy toes. By the end of the night, my husband and I still in limbo about taking her to emergency, we caught her playing ring around the rosie on her own. I guess that is a good sign. OR IS IT???

QUEST ION: My baby was put on antibiotics recently for a possible infection after a chest x-ray. On the third day of giving him the antibiotic he had two bloody bowel movements. He’s had three so far, and I’m worried. His doctor said it was caused by the antibiotic and we should just observe him. What do you think?

DR. BILL: I’ve had several similar questions concerning this topic. Let me refer you to this article to help shed some light. http://www.iammodern.com/pediatrician-guru-blood-in-stool.html

If the blood gets worse, or your child shows other symptoms such as fever, abdominal pain, vomiting, weight loss, or does not improve, return to you doctor for a re-evaluation.

QUESTION:  What is the best kind of vitamin to give my 4-year-old daughter? She is very picky and eats minimal veggies.

DR.BILL: Children at this age can be very picky eaters. My 3½-year old literally runs away from the site of fruits and veggies. We’ve learned to be persistent in keeping the fruit and veggies on her menu. She can eat what she likes, but won’t get anything special or an alternative food if she doesn’t eat the veggies on the plate. As for what vitamin supplement to give her, I usually recommend an age appropriate, regular multivitamin to my parents. We usually use “GummiVites,” but most pediatric multivitamins will do. Some children like the chewable and others the gummies. Some will only take liquid vitamins. I also recommend that you provide the omega-3 fatty acids (like DHA) in her diet. These come in chewable and gummi forms. You can even find many foods fortified with them, such as certain yogurts and butters.

Question: Both of my 2-year old, twin granddaughters had very dark green, almost black loose stools today. Is it something they ate, or is their diet lacking certain vitamins or nutrients? Normally, they are very consistent, although one day last week they were both constipated. At my house, they eat a variety of fresh fruits and vegetables, including broccoli, spinach, carrots, pineapple, bananas, apple sauce, etc.
Dr.Bill: If this is a one-time occurrence, especially if there is no fever, blood in the stool, or pain, then this seems like a harmless problem. Many times children’s stools are affected by what they eat. Other times a simple viral infection can also cause a change in stool color and consistency. A stool’s color normally comes about as a result of the bacteria that are living in our gut. A longer or shorter transition time will affect both color and consistency. If a person is having exceptionally foul smelling stools without any other problem, I usually advise eating yogurt or any food with active cultures/probiotics.

Question: Should our children receive both the regular flu shot and the H1N1 shots?
Dr.Bill: This year’s flu season is shaping up to be a potentially serious one. In addition to the “regular” seasonal flu, which kills 30,000 or more people in the U.S. every year, we are now confronted with something new. Formerly called the Swine Flu, H1N1 flu is a highly contagious virus that seems to have produced relatively mild symptoms for most people who have been infected. However, 525 Americans have succumbed to this infection since April. The H1N1 flu is a more serious infection for the younger population and pregnant women and has a higher chance of causing more complications or even death. What makes it a serious threat is that the spread has gone global, prompting the World Health Organization (WHO) to formally designate it as a pandemic. Unfortunately, all flu viruses have the ability to mutate frequently, so it can easily change into a more virulent strain.

Q:  My 6yr old has a strep infection and now is pooping blood. Is that normal?
A: Your question is a very important one. There are many causes of blood in the stool. My first advice is that you should see your pediatrician immediately for proper diagnosis and treatment.

I am assuming that your child has some form of strep throat and is on antibiotics. As I stated above, there can be many causes of blood in the stool, either because of the infection/antibiotic treatment or another unrelated cause. There’s also the possibility that what you see may not be blood.

The least dangerous possibility is that the red color you are seeing is some sort of dye/additive in the food/drink you child has consumed. A simple test done at the office can quickly tell the difference.

Q: My daughter has been a little loose with her poop for the last 2-3 days after I started her on a probiotic and Flintstones vitamins (no iron). Her stool today was almost black, a little mucous and very dark green. She ate tons of blueberries and cherries today (as a side note). Do I have anything to worry about? No fever, no sickness. Very happy, but has a diaper rash now. She is 2 years old.
A: You’ve now entered the world of “what did my child eat?” In general, loose stools aren’t a big problem. Usually these are associated with either viral infections or a particular food your child has eaten. In general, I do advocate the use of probiotics. I haven’t heard of kids developing loose stools as a result, but you never know how any one person will respond to them. The most likely culprit for your child’s peculiar poop is the blueberries that she ate. Every time my daughter, Marissa, ate blueberries, we were sure to have a giant blue/black surprise in her diaper!
Foods like applesauce, bananas, mashed potatoes, and rice will normally slow down bowel movements, while foods like grapes, raisins, prunes, peaches, and high fiber foods will speed up bowel movements. Also, certain juices will affect the speed of your child’s internal poop generator.
However, if you ever see red, pure black or silver stools, then you should contact your pediatrician to check it out. Red or black may imply blood, which is never normal in stools. The only exception is if you see blood streaks, which could be from a rectal fissure. Silver stools may imply a liver problem. If the loose stools are associated with fever and/or pain, then a thorough evaluation is warranted.
As for the diaper rash, usually a good coating of A & D ointment will help speed up healing. If the rash changes in nature, consult your pediatrician to see if an infection has set in.

Q: My son recently pulled off and killed a tiny tick off his lower abdomen. We think it is a tick and are not sure. The tick was hard to get off according to him, but was not under his skin. After pulling it off, the area was a tiny bit red. Tiny. Gone in complete the next day. It may have been a result of him pinching the bug off of him. Now I hear so many Lyme Disease cases, I am so frightened. What do you think? Would you worry? We kept the bug in case we need to investigate. Does the tick need to be in the skin for a while before contracting disease? Would you worry?
A: Your concern is a valid one, since we do live in a high risk area for Lyme Disease. Humans can get this illness through the bite of a deer tick. These ticks are smaller than dog ticks and can be hard to spot. Here is a website with some good photos of what they look like: http://www.oes.org/html/how_2_identify_different_ticks.html. The tick needs to be attached for 2-3 days to be able to actually transmit the disease to people.
Most people associate Lyme Disease with a "bull’s eye" rash, but more than half of those infected never show this symptom. Instead, they might get conjunctivitis, fatigue, headaches, muscle pain, fever, chills, swollen glands, neck stiffness, facial nerve paralysis or motor tics. Symptoms can appear as early as three days after the bite or as long as months afterwards. Sometimes, there is no known history of a tick bite. It can take as little as 3-4 days or months to years for any symptoms to show.
It’s not uncommon for tick and insect bites to get infected or irritated. A little Neosporin and/or hydrocortisone will help reduce the local redness and swelling. If the mouthparts are still embedded, it’s best to try to remove them to reduce the risk of infection. If you do have a tick attached to your skin, the best way to remove it is to grab it with a tweezer or fingers and gently but firmly pull straight out. Don’t pull fast or jerk it as this will leave a part of the tick behind. Home remedies like dowsing the tick in alcohol or acetone don’t work very well since the tick takes a breath only about once an hour.
I usually advise my parents/patients to watch for the above mentioned symptoms. If they develop them, then I will order a Lyme test. If a patient tests positive, he/she can be treated with antibiotics. Once you get Lyme Disease and are treated, you can still get it again, much like Strep Throat.
The best defense against getting Lyme Disease is to do your best to avoid getting bitten by the Deer tick and doing thorough tick checks after going outdoors. Many patients that I diagnose with Lyme Disease don’t even know that they’ve been bitten by a tick.

I hope this helps.

A: Dear Ms. Mckee, The answer to your question is quite complex since there are so many variables involved. It’s always the hardest situation to deal with when your child does suffer one of these injuries. I remember several years ago, when my daughter first started to walk, like all new toddlers she wanted to walk without any help and always on the hardest possible surfaces around. Imagine my shock when she fell forward onto the concrete sidewalk without even being able to brace herself. First came a hollow coconut sound, followed by what seemed like a very long, quiet pause. Then she let loose howling and screaming and crying. But within minutes she became distracted by a couple of kids riding their bikes, and she completely forgot the head injury. Aside from a few scrapes on her nose and forehead, everything was fine.

What makes head injuries hard to figure out is that the brain is surrounded in its own “space capsule.” As a result, you don’t always see the signs of danger until it’s very late. The hard bones of the skull offer the first line of protection, and the fluid and sacs the brain floats in help absorb the shock from the impact. What typically causes the most concern with parents is the copious amount of bleeding and/or the size of the goose egg on the head. These are usually minor and stop or go away by themselves. The bigger concern is what is going on inside the brain. The types of injuries are either minor or serious.
Patients who have minor head injuries almost never lose consciousness, but may have mild headaches or dizziness lasting a day or two. There should not be any other neurological/behavioral change with that person.

Severe head injuries involve loss of consciousness most of the time, and then the person will develop serious symptoms like: persistent vomiting, extreme lethargy or excessive irritability, loss of function of some body part, worsening loss of consciousness, straw colored fluid leaking from the nose or ears, problems walking or talking, and severe headache. Anytime you suspect someone just had a serious head injury, they should be taken immediately to a medical center for evaluation and treatment.
With a severe head injury, there may be bleeding in the brain or some other swelling. Then the protective “space capsule” becomes the problem. Since the brain is in an enclosed space, if any kind of swelling occurs, it will lead to some sort of brain damage or even death. This is why immediate medical care is important. A quick diagnosis will lead to quick treatment, which most often will save the patient’s life.
With minor head injuries, I advise acetaminophen and observation. I also have the parent wake the child once or twice during the night to see how they respond. Once a 24-hour period has gone by, then the danger risk is probably over.

In Natasha Richardson’s case, she probably had a very slow bleed, which unfortunately delayed the symptoms she eventually showed, and this in turn delayed her being diagnosed until it was too late. Other factors can also complicate head injuries if there are other problems like aneurisms, abnormal anatomy, or bleeding problems.

The best course of action is to seek medical attention immediately if you are uncertain of the extent of the injury. Hopefully this helps answer your question.

Dr. Bill