Wednesday, December 30, 2009


Teething is a process by which the first set of teeth pushes through the gum line. Some babies do not seem to mind this at all but other babies can be very fussy every time a tooth comes through. They refuse to eat and sometimes may just take the bottle or nurse. They will be waking-up several times at night because of discomfort.They can also be grabbing at their ears because of referred pain, same nerve fibers innervate the gum and the ears.This may be associated with low grade fever but once the temperature is more than 101.5F this is most likely not secondary to teething. Teething is not associated with diarrhea or congestion. Most mother's believe that it is the case. Studies have not shown a correlation between this two symptoms. Teething happens from 3 months to 3 years of age. They should have their first set of teeth, 20 in all, by 3 years of age. What to do if your baby is teething? You will notice some swelling in the gum line with the white teeth coming through, this process can occur for several weeks.
  • you can use your clean fingers to massage the area of the gum that is swollen
  • give your baby something to chew on, a wet washcloth that has been put in the freezer for 30 minutes should soothe him, teething rings are good too, just make sure it is not hard as ice because this can cause bruising in the gums
  • acetaminophen is good to help at night when they go to sleep and should last for 4 hours
  • sometimes we can try some baby Oragel or Anbesol only if the baby is very irritable this does not usually last long and I rarely recommend it because it is a topical anesthetic
  • lots of hugs and kisses should work great

I always tell my parents that this is a "rite of passage" and this too shall pass before you know it (after a few sleepless nights).

Tuesday, December 22, 2009

What is the scaly lesion on my child's scalp?

Patient is a 2 year old female who was noticed to have a scaly round patch on the left side of her scalp. She was prescribed several shampoos and was given steroid creams to put on the area but mother noticed that this seem to be persistent for 1 year now and not getting any better. She was then prescribed some Nizoral shampoo which she can buy over the counter and told to follow-up in 1 month. On follow-up apparently the lesion seem to have gotten a lot better but still persistent. Otherwise, she has been a healthy young girl with no other problems. She was them prescribed some Griseofulvin to follow-up in 2 months.

She has "ringworm of the scalp" known as tinea capitis. This is from a group of fungi which invades the layer of the skin, hair and nails. This can be transmitted from animals such as cats or dogs directly or indirectly. This can also be transferred from person to person. The treatment takes a long time because this is a slow growing microorganism. The first line of treatment is Griseofulvin by mouth with Nizoral shampoo twice a week. If we encounter resistance Ketoconazole is another alternative for treatment. Most patients respond well to the medications.
We usually tell parents to make sure child does not share combs, towels with any one, because this can be contagious.

Tuesday, December 8, 2009

Is it a common cold or allergies?

The most common infection in children in the common cold but the significance of this is attributed to the possible complications that it can cause. Children usually have 5-8 infections a year and this is more common in children younger than 2 years of age. 1/3 of the common colds is caused by the rhinovirus but there are 200 different strains of viruses that can also cause this infection. Colds is usually more severe in younger children because it can result is some fever. They can have ear infections with this and if the discharge is more purulent they can have a sinus infection with this. This is very contagious so it is really hard to quarantine children with this illness. Period of infectivity starts a few hours prior to the appearance of symptoms to 1-2 days after the illness appeared.

Babies younger than 3 months of age start with fever, irritability, restlessness and sneezing. Nasal discharge start which can lead to nasal obstuction. They will then have a hard time breathing or eating so it is very important that we help clear their airway by applying some normal saline to the area with some suctioning. In older children, they feel dryness in their throat some nasal discharge with coughing and some fever. They may complain of some muscle aches too. In most cases, the acute phase lasts for 2-4 days.

Allergic rhinitis can be differentiated from the common cold because it is not usually accompanied by a fever and the nasal discharge is usually clear. They have persistent sneezing and itchy eyes.