When your child declares that he is bored this summer, do what I did, and alert the residents of your home that “bored” (or any derivative thereof) is no longer a part of the English language.  Not only is the word banned in our home, but the feeling is not allowed, either.  What is allowed, however, is creative thinking about what activities to pursue.  Here is an age-old solution that still works wonders:

Seek water.  Water soothes the soul and calms the savage beast.  It’s also entertaining in a multitude of ways.  If you can find a pool or a beach, hallelujah.  If you are at home, try the old “running through the sprinkler” idea.  It might be old-fashioned, but it’s still fun.  So are water balloons, watering cans, and playing in the rain, if the opportunity presents itself.

Another thing you can do with water is make lemonade, juice, popsicles, and even mud pies.  (Be sure that the children know which ones are ingestible and which are not.)  Even if you fill a few containers with water and set them outside along with some plastic toys, children of any age will find a way to play.  Water play should always be closely monitored, but water is one of the simplest ways to keep children occupied.

Being prepared is the first step to staying safe in the outdoors. Before venturing out on your trip, spend some time researching the potential hazards of terrain, weather, and wildlife that you might encounter, and pack items that will promote your safety and comfort.

• Know first aid: On a casual family outing, at least one responsible adult should be skilled in first aid. Manual skills such as mouth-to-mouth breathing, cardiopulmonary resuscitation (CPR) and the application of bandages and splints, should be practiced beforehand. Become familiar with the rescue techniques pertinent to the environment in which you will be traveling.
• Carry the right equipment: Be prepared for foul weather conditions. Always assume you will be forced to spend an unexpected night outdoors. Carry warm clothing and waterproof rain gear. Carry survival equipment such as maps, a GPS or compass, waterproof matches, a knife, nonperishable food, a flashlight and first-aid supplies.
• Carry a first-aid kit: First-aid kits should be designed according to the environment to be encountered, number of travelers, medical training of the party leaders, and distance from sophisticated medical care. Remember to bring along pediatric doses when traveling with children. First-aid supplies should be packed to be readily accessible and marked clearly to allow for quick identification. It’s helpful to organize supplies in resealable plastic bags by categories such as “wound care” and “allergic reactions.”

Dr. Greene’s Answer:

With sunburn or any other burn, there can be ongoing damage as long as the skin is hot, so cooling off is wise, such as in a lukewarm bath. Some dermatologists recommend cold milk on the skin to help soothe the pain. Once you’ve cooled off, the greatest ongoing damage comes from the skin drying out, so a soothing moisturizer is good for as long as the burn lasts. I like using one with Aloe Vera in it. Cool compresses are great, followed by moisturizer containing aloe and/or vitamin E oil.

As for the “caine” remedies for sunburn pain, I’m not a big fan. They can cause allergic reactions and don’t work all that well.

I like ibuprofen for the pain. It works best when the pain is caused by inflammation (red, tender, hot, or swollen tissue.) It is anti-inflammatory so it stops the pain at the site of the inflammation. Acetaminophen can work instead or in addition, but it does not help inflammation. It just works at the pain centers in the brain.

Related concepts:

External otitis; otitis externa

Introduction to swimmer’s ear:

Swimming can be a delight for children and for parents. Although water in the ear from swimming or bathing is not associated with most types of ear infections (even for children with tubes!), it can cause one kind of ear infection as well as exquisite pain.

What is swimmer’s ear?

Swimmer’s ear is an infection of the skin that lines the ear canal. A waxy, water-resistant coating usually protects this skin. Bacteria normally live on the surface of the skin with no ill effect.
If there is a break in the skin’s normal barrier, these bacteria can slip inside the skin, causing an infection called external otitis or swimmer’s ear. This is different from otitis media.
What creates a gap in the protective barrier of the skin?
If the ear remains wet for long, moisture penetrates the water-resistant layer and the skin becomes prune-like in the same way that one’s fingers and toes become soft and wrinkled when they remain in water. Bacteria can easily move into this soft skin.
Tiny scratches in the ear canal (usually from sticking a finger or some other object into the ear) also leave the skin vulnerable to infection.
The skin can even be breached as a result of the ear’s becoming extraordinarily dry, causing the skin to crack. Ironically, swimmer’s ear can be the result of spending time in desert conditions.

Who gets swimmer’s ear?

Preschool and school age children get swimmer’s ear more than anyone else. Babies and toddlers are usually spared from swimmer’s ear, even if their ears get wet. Adolescents and adults are at risk.
Children with eczema or seborrhea are at higher risk than their peers.
Swimmer’s ear is more common in people who swim in pools than in people who swim in lakes. Perhaps this is because the chlorine in swimming pools disproportionately kills the gentle, beneficial bacteria in the ear canal, giving the aggressive bacteria freer reign.

What are the symptoms of swimmer’s ear?

People with swimmer’s ear usually complain of an itchy and/or painful ear. The pain can be quite severe. The ear is particularly sensitive to the ear lobe’s being moved up and down.
The earwax may appear soft and white, and there may be a small amount of clear discharge.
Sometimes hearing is decreased during swimmer’s ear. Rarely the infection can become quite severe.

Is swimmer’s ear contagious?

No

How long does swimmer’s ear last?

Swimmer’s ear will usually disappear within 2 to 3 days of treatment.

How is swimmer’s ear diagnosed?

It may be diagnosed from the history and/or the physical exam. With severe infections, cultures may be necessary to identify the specific bacteria or virus involved.

How is swimmer’s ear treated?

Early or mild swimmer’s ear can often be treated with a few drops of white vinegar placed in both ears provided that the ear drums are normal and intact. Put the vinegar in one ear and leave it for about five minutes before turning that ear down in order to drain the vinegar solution. Repeat this twice a day for three days.
If the symptoms worsen or persist for over three days, prescription antibiotic drops may be necessary. They are effective the great majority of the time. Some prescription drops also contain topical steroids which can rapidly help pain and swelling in the ear. Sometimes oral pain medicines are also necessary.
Rarely, oral or even IV antibiotics are needed.

How can swimmer’s ear be prevented?

The first step to prevent swimmer’s ear is to make sure the ears get dry after being in the water. Turning the head and gently pulling the ear in different directions helps to drain water out of the ear. Try drying the opening of the ear very carefully as far as you can reach with a towel.
If swimmer’s ear becomes a recurrent problem in children with normal, intact ear drums, you can put a few drops of rubbing alcohol into the ears each time they become wet to facilitate drying.
Another good option is instilling a few drops of white vinegar. The acetic acid inhibits the growth of bacteria in the skin.
Controlling seborrhea or eczema can be helpful for affected children.

Related A-to-Z Information:

Ear Infection, Eczema, Impetigo, Otitis Media with Effusion (OME), Seborrhea (Seborrheic dermatitits)

Related concepts:

Tanning, Radiation damage

Introduction to sunburn:

Even though skin cancer occurs in adults, the serious skin cancers are caused by the radiation damage (particularly the sunburns) that occurred in our youth. Similarly, adult cataracts can result from too much sun in the eyes during childhood.

What is sunburn?

Sunburn is visible radiation damage to the skin.
Most of the damage is caused by UVB radiation, although UVA radiation can also contribute to the damage. Radiation risk has increased greatly over the last twenty years.

Who gets sunburn?

Children are at the highest risk. More than half of a lifetime’s sun exposure usually happens during childhood.
The lighter the complexion, the greater the risk of radiation burns from the sun. Higher elevation also increases the risk. Some medicines also make the skin more susceptible to damage.
UV radiation reflects off of snow, sand, water, cement, and even grass, increasing the potential for damage. People often feel safer on a bright cloudy day, but significant sun damage can still occur.

What are the symptoms of sunburn?

In mild sunburn, the skin is red, hot and painful. Usually, the symptoms are noticed 6 hours or more after the first exposure and peak within 24 hours.
Moderate or severe sunburn often begins the same way, but continues to progress –often peaking in the second 24 hours. Symptoms may include radiation-induced blistering of the skin, nausea, fever, chills, headache, and even heat stroke.
Dehydration can result.

Is sunburn contagious?

No – although the behavior leading to sunburn is often contagious.

How long does sunburn last?

Mild sunburn usually lasts 3-5 days. Moderate or severe sunburn usually lasts at least several days longer.
The effects of each episode of this radiation damage, however, are long lasting. Each sunburn increases the risk of early wrinkles, premature aging, senile skin lesions, and skin cancers.
One of my college roommates met a tragic early death from malignant melanoma. He was a sports enthusiast who frequently spent hours unprotected in the sun — he always had a tan. Unfortunately, he’s not alone. The risk of developing malignant melanoma has more than tripled since 1980 — from one in 250 to one in 71. A person dies every hour from melanoma in the US. Skin cancer was once a disease of the middle-aged and elderly, but it is becoming a disease of people in their 20′s and 30′s. The skin damage that will result in melanoma most often happens during childhood — but kids have a hard time imagining 20 years in the future. It’s our job as parents to protect them. Who would have guessed that a cool hat could be a lifesaving gift for our kids!

How is sunburn diagnosed?

Sunburn is diagnosed based on the history and physical exam.

How is sunburn treated?

The radiation damage from sunburn is irreversible. No treatment exists.
Cooling the skin and keeping it from drying out can prevent further damage. Thus, cool compresses are the first line of treatment. Brief, lukewarm Aveeno baths may also be helpful. This can be followed by an alcohol-free moisturizer cream or lotion. Vitamin E or Aloe can be helpful ingredients. Topical anesthetics do not provide much relief and can lead to unpleasant reactions.
Anti-inflammatory medicines, such as ibuprofen, can reduce redness and pain.
If there is blistering, fever, or dehydration, the child should see a physician for further evaluation and treatment. Sometimes topical or systemic steroids are needed. In very severe sunburns, children may need to be hospitalized.

How can sunburn be prevented?

Sunscreen, loose clothing, and hats help protect children’s sensitive skin.
Try to avoid the sun’s most intense rays by staying out of the sun during the middle of the day. And don’t be lulled into complacency by overcast days, since most of the sun’s harmful rays will get through the clouds. Be especially careful if you are around water, sand, snow, or any surface that will reflect and therefore intensify the sun’s rays. Remember, the sun’s rays are more intense the higher you get in elevation.
The AAP used to recommend not putting sunscreen on infants under six months of age. This is no longer the case, because the danger from sunburns outweighs the risk of sensitivity to sunscreens.
When purchasing sunscreen, select a PABA-free brand with an SPF of at least 15. In general, infants’ skin is much thinner and more sensitive to the sun than adults’ skin, even in individuals with darker complexions. The amount of sunscreen needed depends on how light the child’s complexion is and I would recommend using sunscreen with an SPF of 30 or greater for fair-skinned children. Sunscreen is most effective if first applied 20-30 minutes before sun exposure. Use sunscreen whenever you expect to be in the sun for thirty minutes or more, and re-apply after swimming. Even waterproof sunscreens should be re-applied every 80 minutes or so, after being in the water.
Parents often think to apply sunscreens to exposed areas of skin, such as the face, but feel safe about areas under the clothes. Ultraviolet radiation, however, can penetrate clothes. Prolonged exposure can damage the skin. Typical cotton T-shirts offers sun protection equal to only SPF 7.
One solution for long outdoor days: sunscreen under the clothes.
A less messy solution: sun-protective clothing.
Sun protection depends on the fiber, weave, and fabric color. Sometimes a substance that blocks UV radiation is added to the fabric. The ultraviolet protection factor (UPF) of fabrics is similar to the SPF of sunscreens. A high UPF (40 to 50) is nice, because the ongoing sun protection is affected by stretching, shrinking, wetness, laundering, and the normal wear and tear of childhood.
Sunglasses protect children’s eyes from the UV rays and decrease the risk of cataracts in adulthood.
Most children love to be outdoors. By all means, take your children outdoors and enjoy. While you are giving your children a good time, though, you can also give them the gift of future good health by being careful. Protecting your children’s eyes from the dangerous rays of the sun and protecting their skin from sunburns is a gift that will last their whole lives.

Related A-to-Z Information:

Cataracts, Dehydration, Headache, Heat Stroke, Lyme Disease, Poison Ivy, Oak, and Sumac, Vomiting

Introduction to sprains:

Sprains, strains, and active play…“I sprained my knee,” or “I have an ankle strain.”Ankles and sprains often go together in people’s minds, but beyond that, the distinction between sprains and strains often seems fuzzy.

What is sprains?

Strains are injuries to muscles, or to the tendons that connect muscles to bones. Strains may happen near joints, but not within joints.
Ligaments are the bands of connective tissue that hold bones together in the skeleton. A sprain is an injury to one of these ligaments. Because of this, sprains happen at joints – places where two bones are connected.
In a severe sprain (grade 3) the ligament is completely severed. If the ligament is only partially torn (grade 2), the body is able to repair itself more quickly and more reliably. In a mild sprain (grade 1) the affected ligament is only over-stretched, not torn. It can still be quite painful.

Who gets sprains?

Fractures are more common in children than sprains. In general, children’s fibrous ligaments are even stronger than the growing parts of their bones.
Ankle sprains are easily the most common sprains in children (especially young children), followed by sprains of the knee or the wrist.
Ankle sprains are also the most common ankle injuries, and knee sprains are the most common knee injuries (although a knee sprain is often referred to by the specific ligament that is damaged).
Sprains are most common among those participating in sports, but can occur in any child. They are also commonly associated with scooters, bicycles, skateboards, skates, playgrounds, and trampolines.
Sprains are most common when someone who is jumping comes down on the outside of the foot in a way that stretches or tears the ligaments on the outer side of the ankle. Ankle fractures are also common in children.

What are the symptoms of sprains?

Mild sprains (grade 1) have mild swelling, mild tenderness, and perhaps some mild bruising around the joint. Movement of the joint may be somewhat decreased. In a mild ankle sprain there may be some limp, but children are able to walk and perhaps even to hop.
Moderate sprains (grade 2) are accompanied by more swelling and more tenderness (a greater degree and also more of the joint feels sore). There is usually bruising around the joint, and movement of the joint is decreased. Children with moderate ankle sprains are unable to run or hop, and can walk only with an obvious limp.
Severe ankle sprains (grade 3) have obvious bruising, accompanied by diffuse swelling and tenderness around the joint. The joint is obviously less mobile. Children with a severe ankle sprain are usually unable to bear weight on the ankle.

Is sprains contagious?

No. Although the behavior that leads to sprains may be. :-)

How long does sprains last?

Mild sprains usually heal within 2 weeks (often sooner). Moderate sprains usually heal within 4 weeks (and often sooner than that). Severe sprains usually last longer than a month, and some will not heal without surgery.

How is sprains diagnosed?

A sprain may sometimes be diagnosed based on the story and the physical examination. Sometimes x-rays or other imaging studies are needed to clarify the diagnosis and rule out a fracture.

How is sprains treated?

Rest, ice, compression, and elevation (R.I.C.E.) are the foundation of sprain treatment. Moderate or severe sprains may need a splint or a cast to hold the injured joint in the right position for healing. Exercises are often prescribed to speed healing. Some moderate or severe sprains may also benefit from physical therapy.
Some children with severe sprains require surgery to repair the damaged ligament.

How can sprains be prevented?

Active play is wonderful for children (and for adults!). Many sprains can be prevented by supervising children during active play. Children’s sports should be a vehicle for teaching safe play.
Once a joint has been sprained, repeat sprains are common. These may often be prevented by correctly rehabilitating the joint after the first injury.
Wearing high top shoes can reduce ankle sprains.

Related A-to-Z Information:

Arthritis (Juvenile rheumatoid arthritis, JRA), Bowlegs, Clubfoot, Congenital Hip Dislocation, Elbow Subluxation (Nursemaid’s elbow), Fractures, Heat Stroke, Hernia (Inguinal hernia), Muscular Dystrophy, Scoliosis, Spina Bifida, Sunburn, Tibial Torsion (Turned-in feet), Ticks, Torticollis, Toxic Synovitis

Related concepts:

Arthropods

Introduction to ticks:

The possibility of tick-borne illnesses such as Lyme disease, Colorado tick fever, and other arboviruses, gives a sense of urgency to this topic.

What are ticks?

Ticks are a family of bloodsucking arachnids. They are related to mites, such as those that cause scabies, but are larger. They are related to spiders, but have shorter legs.
Ticks attach themselves to warm-blooded animals to feed. In doing so, they spread diseases from the blood of one animal to another.
People suggest many methods for removing ticks: applying rubbing alcohol, smothering with Vaseline, painting with fingernail polish, twisting clockwise (or counterclockwise), and touching with a hot match.
Though these methods are popular, they are not the best. They can even increase the risk of disease.

Who gets ticks?

People and animals who spend time outdoors in woods or tick-infested areas are most likely to be bitten by ticks. Generally, children are more likely to be bitten than adults.

What are the symptoms of ticks?

The tick bite is often painless, so that the tick is only noticed in a reasonable amount of time if someone checks for ticks after returning from a tick-infested area.

Are ticks contagious?

Ticks can spread many different contagious diseases. Ticks move from one warm-blooded animal to the next in order to feed.

How long does ticks last?

Lyme disease is most likely to spread when the tick has been feeding for at least 36 hours. Ticks will tend to remain in place at least that long unless discovered and removed.

How are ticks diagnosed?

An attached tick may be discovered accidentally or when someone searches for ticks intentionally. The ticks may be well hidden in hairy parts of the body.

How are ticks treated?

Use tweezers to grasp the tick as near to the mouthparts and as close to the skin as possible. Pulling perpendicular to the skin, use gentle, steady force to remove the tick. The site should then be thoroughly cleaned and disinfected with alcohol or another disinfectant.
The tick can be killed by soaking it in rubbing alcohol or flushing it down the toilet. It should not be crushed or squeezed. Hands should be washed afterwards. Check with your pediatrician or local health department to see if they want to collect the tick for monitoring purposes.

How can ticks be prevented?

Tick bites may be prevented by protective clothing, insect repellants, and by making wise choices for outings.
Prolonged tick bites may be prevented by carefully inspecting children and their pets when they return from spending time in a potentially tick-infested area.
Prompt and complete removal of ticks does help prevent illness. This is a situation where the folk remedies can do more harm than good.

Related A-to-Z Information:

Arboviruses, Arthritis (Juvenile rheumatoid arthritis, JRA), Encephalitis, Epilepsy, Exanthems (Childhood rash), Headache, Lice, Lyme Disease, Meningitis, Pinworms, Plague, Poison Ivy, Oak, and Sumac, Rabies, Scabies, Sunburn

Introduction to poison ivy, oak, and sumac:

It’s Monday morning. You’ve had a wonderful weekend playing with your kids and your dog, romping through the woods. Now, as you lie in bed, you hear whimpering coming from the next room. A few minutes later, your son comes in to join you in bed, sporting red itchy patches on his arms and legs. He has poison oak (or poison ivy, or poison sumac).

What is poison ivy, oak, and sumac?

Poison ivy, poison oak, and poison sumac together produce more cases of allergic contact dermatitis than all other allergens combined. The resulting rash can be anything from mildly unpleasant to a true emergency with intense swelling, blistering, and oozing. With even a moderate case, as you may have experienced, the itching can seem unbearable.
Whichever of these plants he came across while playing, the culprit is the same — an oil called urushiol. This oil is found in the leaves, roots, and twigs of these plants. There is no difference in the rashes, since there is no difference in the cause. A few other plants contain the same oil in lesser amounts, including the Japanese lacquer tree (and thus some lacquered furniture), the gingko tree, the shells of cashews, the shells of brazil nuts, and the rinds of mangoes. Extra sensitive individuals would do well to avoid all of these.

Who gets poison ivy, oak, and sumac?

Most people will have no reaction the first time they are exposed. In fact, children under the age of 7 are rarely sensitive. Sensitivity is particularly rare under the age of one, and when infants do break out, the rash is usually mild. As many as 15 –30 percent of individuals never develop sensitivity.
The rash is most common in the summer, but it can occur at any time of the year.

What are the symptoms of poison ivy, oak, and sumac?

Wherever the oil touches the skin of a sensitive individual, an exquisitely itchy, red rash will appear between 8 and 72 hours (usually 12-48 hours) later, which will often go on to develop blisters. The first time a person touches this oil, s/he may break out 7 to 10 days later. The rash usually looks like lines, streaks or patches where the oil came in contact with the skin (Healthy Children, AAP June 2010).

Is poison ivy, oak, and sumac contagious?

The oil from poison plants can stick to virtually anything. It can dry and remain potent indefinitely. This is why camping trips can produce such horrible cases of poison oak. Anything that your child has touched between his exposure and a thorough shower should be washed in soap and water (preferably hot), hosed down, or soaked in water and alcohol. This includes clothing, shoes, balls, toys, tools, and the towel he used after his shower. After washing the contaminated articles, don’t forget to wash your own hands, and anything those articles touched.
Once the oil has been removed, the rash from poison oak or poison ivy is not contagious. Even the oozing blisters are not contagious, although they look like they should be. Because new blisters can keep appearing over the course of a week, people assume that touching the rash causes it to spread, or that the ooze itself is responsible for the spreading. The fluid that fills the blisters is one’s own serum, not the poisonous oil. The skin only breaks out where it actually is exposed to the urushiol. The sensitivity of the skin, and the amount of oil, determine the speed of the eruption. Places where the oil is most concentrated, or the skin the most vulnerable, break out first, followed days later by places where there was only a little oil, or the skin is a more effective barrier. Woe to those with eczema!
As long as the oil is no longer present, scratching does not make the rash spread. Scratching does make the already intense itching even more unbearable and can cause the rash to get infected. Some doctors recommend cutting your child’s fingernails short to prevent scratching and infection.

How long does poison ivy, oak, and sumac last?

The rash usually lasts about two weeks.

How is poison ivy, oak, and sumac diagnosed?

The diagnosis is based on the history and the physical exam.

How is poison ivy, oak, and sumac treated?

Most people find that cool compresses in one form or another are quite soothing. Try using a towel or washcloth soaked in either plain tap water or Burow’s Solution (an astringent solution — you can make it yourself using Domeboro tablets or powder packets available over-the-counter). A fan blowing over the cool compress can help. As the skin is cooling, the blood vessels constrict, cutting down on the itching and the new ooze. This is especially good during the two or three worst days of the rash.
Along the same lines, some dermatologists recommend rubbing an ice cube gently over the rash several times a day, then letting the skin air dry.
Soaking in a tub, especially using an oatmeal bath such as Aveeno, can also be very soothing. Be sure the bath is cool or lukewarm — but not hot — as heat tends to make the rash even more inflamed.
After the cooling, coat the rash with a shake lotion such as calamine. This continues to relieve the itching and helps to dry up the blisters. Be sure to check the expiration date on an old calamine bottle in your medicine cabinet, since it may not be effective after the expiration date.
Smearing on hydrocortisone, or other topical corticosteroids, will help suppress the itching a bit and give temporary relief, but does little to hasten the drying up of the rash.
Taking an oral antihistamine can help with the itching quite a bit, although it does not speed up resolution of the rash. Taking benadryl at nighttime will make most people drowsy and help them sleep through the night without itching. Again, don’t use benadryl cream or spray topically, because this can cause its own skin reaction.
The goal of reducing itching is brought about by cooling (by restricting the blood vessels), by drying the rash, or by quieting down the allergic response.
In severe cases of poison ivy, poison oak, or poison sumac, it is a good idea to see a doctor. Sometimes large blisters need to be drained and sometimes an oral steroid such as prednisone may be useful. Systemic steroids produce rapid resolution of both the itching and the rash. If they are needed, a gradually tapering dosage over about 12 days should be given. The dosage needs to be tapered to avoid side effects after discontinuing use, and the entire course should be taken since stopping earlier may result in a rebound rash as bad as the original.

How can poison ivy, oak, and sumac be prevented?

The best way to prevent an outbreak of poison oak is to avoid any contact with the oil in the first place. Teach your children to recognize the poisonous plants of your region. Poison ivy has three leaves that grow on a single red stem. The leaves turn bright red in the summer. The plant grows in all areas of the U.S. except the Southwest. Poison oak is a shrub and is found on the West Coast of the U.S. Poison sumac is also a shrub that typically grows in swampy areas around the Mississippi River area of the U.S. and has 7-13 leaves arranged in pairs along it’s stem (Healthy Children, AAP June 2010).
Before an outing to an area where you are concerned that these plants may be lurking, you might want to coat your child’s skin with a barrier cream. Hollister Moisture Barrier, Hydropil, IvyBlock and Stoko-Gard Outdoor Cream are all fairly good at protecting the skin from the oil, but must be reapplied hourly to remain effective.
Again, the oil is the culprit. As soon as you suspect that your child is exposed to urushiol, have him wash thoroughly with lots of warm water and soap. (Hot water opens the pores, and may transiently increase exposure.) Water alone will also work, but not quite as well. If you don’t have water, use rubbing alcohol. Don’t use a washcloth, since this tends to spread the oil to other patches of skin. Likewise, a shower is much preferable to a bath. Have him rinse thoroughly. If the oil is removed within 5-10 minutes, you may prevent, or at least minimize, the rash. Even if he doesn’t wash for a long time, washing is still very important. The oil remains on the skin until it is rubbed or washed off. It can cause a new reaction wherever it touches — thus, after the forearms and lower legs, the most common spot for a poison ivy rash is the male genitalia!
Perhaps in your weekend outing you were exceptionally careful. You and the kids stayed on the path, and you saw no poison oak or ivy — but your dog went chasing after a bird. When he rejoined you, his fur was coated with oil. The oil transferred easily when he rubbed against your son’s clothing, or when you leaned down to pet him. Thus, the last tip for prevention — don’t forget to hose down the dog!

Related A-to-Z Information:

Allergies (Allergic Rhinitis), Chickenpox (Varicella), Cold Sores (Herpes simplex), Eczema, Exanthems (Childhood rash), Impetigo, Ringworm (Tinea corporis), Sunburn

Related concepts:

Borrelia burgdorferi

Introduction to lyme disease:

Even with our long history on this planet, new discoveries about microscopic neighbors continue to be made. In the 1970s, it was Legionnaire’s disease. In the 1980s, it was AIDS. In the 1990s, Hantavirus made the headlines.
The story of Lyme disease is particularly interesting for two reasons. One is that it illustrates the power of mothers to affect the health of their children, and two, it’s an excellent example of those many situations in our lives, which if attended to at an early stage, are very simple to remedy, but if allowed to take root and grow, become significant problems.

What is lyme disease?

Lyme disease was first brought to medical attention in 1975, when two mothers living in Lyme, Connecticut became frustrated by the lack of concern given to the unusual illness spreading through their community on the banks of the Connecticut River. These two women began to clamor for an investigation. One contacted the Connecticut State Health Department, and the other contacted physicians at Yale Medical Center. Their initiative set in motion a massive investigation, which in 1982 culminated in the discovery of the causative bacteria by Dr. Burgdorfer and colleagues. The bacteria was named Borrelia burgdorferi. At the outset of the investigation, it was noticed that the incidence of Lyme Disease was 30 times greater on the East Bank of the Connecticut River than on the Western Bank. Interviews with affected children and adults and their neighbors revealed that those who exhibited the illness were much more likely to have a cat, a farm animal, a pet with ticks, or a tick bite in the year preceding the illness. As a result, ticks were identified as a likely mechanism for infection. Then, in 1982, Dr. Burgdorfer found the bacteria on a type of deer tick.
Lyme disease is a tick-borne bacterial illness.

Who gets lyme disease?

Lyme disease has been found in 49 of the 50 United States. It is the most common disease caused by a bite in the United States.
Lyme disease is also common in Europe (particularly in Scandinavian countries and in Central Europe — especially Germany, Austria, and Switzerland), but is found throughout the world, including in Australia where none of the ticks are known to exist. Humans are not the only ones susceptible to Lyme disease; dogs and horses also get it.
The bacteria live in deer and white-footed mice who do not develop the illness. When the appropriate tick feeds on one of these animals, it may become infected.
When an infected tick lands on someone, the bacteria are injected into the bloodstream through the saliva of the tick or deposited on the skin in tick feces. Thankfully, most ticks are not infected.
Even if someone is bitten by a nymphal stage deer tick that is infected, the risk of acquiring Lyme disease is only about 8 to 10 percent. It takes hours for the mouth parts of a tick to plant fully into the skin and much longer (days) for the tick to feed. Experiments have shown that it takes more than 36 hours of feeding before the risk becomes substantial.

What are the symptoms of lyme disease?

The symptoms in Lyme Disease can be divided into three stages. In the first stage, a characteristic skin rash is the most prominent feature; in the second stage cardiac and neurologic findings predominate; and in the third stage, arthritis is the classic symptom.
The classic early manifestation of Lyme disease is a round rash called erythema migrans. The rash usually occurs at the site of the bite 7 to 14 days after the tick has bitten, though it has occurred as early as 3 days and as long as 32 days later. Without treatment, the rash gradually expands (hence the name migrans) to an average of 6 inches in diameter, but may be as large as 26 inches. The rash remains present for at least one to two weeks and usually twice that. At this stage, treatment is very simple with common antibiotics. The symptoms usually resolve within several days. People with the skin lesions may have no other symptoms, but may also feel fatigue, headache, stiff neck, joint aches and pains, and sometimes nausea, vomiting, and sore throat. There is often a low-grade fever, but it can be as high as 104 degrees F with chills.
Neurologic abnormalities occur roughly four weeks after the tick bite, but they can occur as early as two weeks after the bite and up to months or even years later with a wide spectrum of involvement. It may be something as mild as meningeal irritation and headache, but can be as severe as meningitis or encephalitis. Cardiac abnormalities occur in only about 10 percent of patients, averaging five weeks after the tick bite and thankfully are relatively brief, lasting no longer than six weeks.
The arthritis of the third stage usually begins five to six weeks after the bite, although it may occur as early as one week afterwards or as late as many months later. Large joints, often those closest to the initial rash, are most often affected.

Is lyme disease contagious?

It is not spread from person to person, except by blood transfusions or blood exchange.

How long does lyme disease last?

Lyme disease can last until treated. Treatment may last for 4 weeks.

How is lyme disease diagnosed?

The diagnosis is suspected because of the clinical picture, including the rash and/or flu-like illness in the summer. The diagnosis is confirmed by blood tests, although false negative and false positive blood tests are common.
Should you try to save the tick? It’s a good idea to bring the tick to your pediatrician or the public health department for visual identification. The current recommendation, however, is not to have all ticks actually tested for the Lyme bacteria, since even if it is present there is at least a 90 percent chance that the bitten person would not have contracted the disease.

How is lyme disease treated?

Treatment of early disease usually includes 14 to 21 days of appropriate antibiotics. The rash usually resolves in a few days. Treatment of late or complicated Lyme disease often requires IV or IM antibiotics for 21 to 28 days.

How can lyme disease be prevented?

Preventing prolonged tick bites is the best way to prevent Lyme disease. Children should wear long sleeves and long pants tucked into socks whenever outdoors in endemic areas. They should be inspected carefully (especially the hairy parts of the body) when returning from tick-infested areas and the ticks should be removed promptly.
Should everyone who is bitten get amoxicillin just in case? Experts have worked out what would happen if everyone who was bitten by a tick were to receive amoxicillin. Even though amoxicillin is a gentle antibiotic, there would be more suffering from side effects and allergic reactions than the suffering it would prevent by getting a jump start on treating those who actually have Lyme disease. It’s better to wait for the first signs and symptoms before treating.
No vaccine is available to prevent Lyme disease. In 1998, the FDA had approved a vaccine for people 15-70 years of age, but iIt’s manufacturer removed it from the market in 2002.

Related A-to-Z Information:

Arboviruses, Arthritis (Juvenile rheumatoid arthritis, JRA), Body-Fluid Transmission, Diphtheria, Encephalitis, Exanthems (Childhood rash), Headache, HIV, Impetigo, Influenza (Flu), Rabies, Scarlet Fever, Strep Throat, Sunburn, Ticks, Toxic Synovitis, Vomiting

Related concepts:

Heat cramps, heat exhaustion, heat prostration

Introduction to heat stroke:

Whether it’s a baby at the beach on a hot day, a toddler left in a sweltering car, or a budding young athlete at an exhausting practice in the sun, heat injuries are more common than people think.

What is heat stroke?

We are warm-blooded. Our bodies produce heat. When a muscle contracts, only about 25 percent of the energy is used for the muscle work. A surprising 75 percent of the energy is turned into heat to keep our temperature up.
If we didn’t have a way to get rid of extra body heat, our temperatures would keep on climbing. Strenuous exercise would raise the body temperature by about 2 degrees every five minutes, reaching fatal levels in only about 20 minutes.
We get rid of extra heat by radiating it to the cooler surrounding environment, by evaporating extra fluid, and by letting air currents carry it away through convection.
If the surrounding air temperature is hot, if the air is not moving, and if the person is getting dehydrated, heat becomes dangerous.

Who gets heat stroke?

The smaller the child, the less likely he is to be able to tolerate heat, especially if he is already a bit dehydrated or has a fever, and if there is poor air circulation.
Heat injuries can occur at any age. Sports and physical activity are generally beneficial and healthy for adolescents; nevertheless, heat injuries are among the leading causes of sports deaths.
People who have a prior history of heat injury, who are taking medicines or drugs (including antihistamines, Ritalin, thyroid hormone, some colic medicines, bed-wetting medicines, diuretics, or laxatives), or who have underlying illnesses (such as diabetes, cystic fibrosis, vomiting, diarrhea, bronchiolitis, or a variety of skin disorders) are at higher risk.

What are the symptoms of heat stroke?

Children’s skin can be quite sensitive to heat. Nursing mom’s often discover this, especially in the summertime, when their baby’s face turns red where it is against the mother’s skin. This redness comes from blood vessels in the area dilating to cool the skin down. Cooling the skin usually makes the rash disappear within hours, or even sooner. Prickly heat (miliaria rubra) is a type of heat rash that lasts.
Heat cramps are common with physical exertion. They usually affect the calf or hamstring muscles.
Heat syncope is fainting due to heat/dehydration.
Heat edema is swelling of the hands or feet from heat. People sometimes get this condition when initially exposed to hot weather.
Heat tetany is tingling, especially of the wrists. Hyperventilation in hot weather can cause heat tetany.
Heat exhaustion usually entails a body temperature of 101 to 104, headache, nausea, vomiting, dizziness, and fainting. It is important to recognize and treat heat exhaustion immediately.
Heat stroke is very serious. A person’s temperature rises over 104 degrees and he or she has an altered mental status. 50 percent of those with heat stroke die from it. There are two types of heat stroke: exertional, with profuse sweating; and classic, in which the skin is hot and dry. Classic heat stroke builds up over days and is most common in infants and in the elderly. It is a true emergency.

Is heat stroke contagious?

Although the desire to appear “tough” on a sports team can be contagious, heat injuries themselves are not contagious.

How long does heat stroke last?

Heat injuries generally last until the body temperature and fluids have been corrected, and any complications treated.

How is heat stroke diagnosed?

The diagnosis is suspected by paying close attention to temperature, airflow, exertion, and hydration. Watching for early symptoms is the key to prompt diagnosis.

How is heat stroke treated?

Heat cramps usually respond to gentle stretching and to re-hydration, especially with an electrolyte solution.
Heat syncope usually responds to cooling (a sponge bath), lying down, and drinking fluids.
Heat edema often goes away on its own, as the person adjusts to the heat.
Heat exhaustion is an emergency. Treatment includes cooling, fans, drinking liquids, and applying ice over the groin and armpits. People typically respond well but prompt treatment is necessary in order to prevent the condition from progressing to heat stroke where treatment may no longer be effective.
Heat stroke is very serious. Call 911. Initial attention should be paid to basic CPR (airway, breathing, and circulation). Aggressive cooling is important, with cooling fans and ice. The patient needs liquids as soon as possible, preferably IV fluids.

How can heat stroke be prevented?

Heat injuries can be prevented. Ensuring good hydration and air circulation are vital. Children should never be left alone in a car. Take care when spending time outdoors in the hot sun.
Children should drink before exercise or sports, and every 20 minutes throughout. Cool liquids are better than warm. Water is fine for exercise up to an hour, but electrolyte solutions are better for exercise that is more strenuous. Keep in mind that most children will not drink this frequently on their own while playing or exercising – they need frequent reminders to ensure that they stay well hydrated.
Lightweight clothes that breathe are preferable, and athletes should have time out of helmets at least every 30 minutes.

Related A-to-Z Information:

Dehydration, Diarrhea, Headache, Miliaria, Vomiting