Photo credit Jacob Moore (elementmotif.com and oilfieldimaging.com)
Another weekend down, another injury free weekend at 4 yo t-ball so that I haven’t felt compelled to out myself as a pediatrician to my son’s team.
Ankle sprains are one of the most common sports injuries in older children/teens. All sports (except running) have some side-to-side movement that any “graceful” athlete can tip over and hurt themselves. Even if your child avoids tripping over themselves, they can step on bases and other children’s feet.
What do you do with a sprained ankle?
- Rest-No need to completely restrict movement. Should be allowed to do what they can (walk, run then sport when pain improving).
- Ice-Apply 20 minutes twice a day.
- Motrin-To help with pain and inflammation.
Who needs a doctor’s visit?
- Pain is severe
- Pain in lower leg bones or bumps at the side of the ankle
- Unable to put any weight on the foot
Who needs a brace?
Only those that have had repeat ankle sprains. Bracing after the first sprain is unnecessary and potentially harmful.
I would only recommend bracing in conjunction with your doctor. Too many kids are wearing braces around indefinitely with no plan.
Warts are one of the most annoying problems.
They are not caused by holding (or kissing) frogs but, instead, are caused by viruses.
The virus that causes warts is contagious but that does not necessarily mean that if your child touches a wart they will get one.
Warts will go away on their own without treatment (Say it with me now.) It never feels like that when it’s your own child, but I promise they will. It may take 6 months to 2 years but they will go away.
There are many strategies for taking care of warts at home.
- Bath or shower
- Use an emery board to file the dead skin on the surface
- Apply the topical wart remover
- Cover the wart with a band-aid
Place a strip (or ring if on the finger/toe) over the wart. This strategy may take weeks or months of coverage to work but it does work (studies even show it)
Wart removal can be done but I only recommend it for warts that are painful or in a location that makes activities (writing, etc) difficult.
The most common types of removal are freezing and laser therapy.
Has anyone ever said this before?
First you’re annoyed, then you start to get a little more concerned. Could something be wrong?
This is usually normal and will go away but there a few things to think about:
Urinary tract infection
It will usually be accompanied by pain with urination, fever or belly pain.
The child will also typically have increased thirst or hunger and weight loss. It is pretty unusual to diagnose diabetes from frequent urination in young children but I have had a 2 year old in my practice that was so not impossible.
Both of the above require a urine sample so going to the doctor is a must.
The most common cause. Two reasons, the child is not emptying their bladder when they do go (usually nervous about missing something) or they have gotten in the habit of going as soon as they feel the slightest stretch on the bladder.
You can help with these problems by having your child go “just a little bit more” after they go and by asking them to wait a minute or two after they say they need to go in order to go.
It’s not uncommon for a child to complain of pain with urination.
There are 3 common reasons for this:
1) Randomness-Happens once or twice
Sometimes best to tell your child that everything is ok and ignore the symptom a time or 2. If they cannot urinate, there is fever or stomach/back pain then go ahead and get things check out.
2) Urinary tract infection
Vary from mild pain to having a very sick child with fever and vomiting. A urine sample to determine if infection is present. Ask for a cup when you walk in the office so that if your child does need to pee, you can go ahead and collect the sample. Treatment is usually an antibiotic that your child takes at home. If your child is more ill with severe pain or signs of dehydration, IV antibiotics may be necessary.
3) Irritation at the opening near where the urine comes out of the body
If the urine sample is negative, your doctor will likely take a look to determine if there is any redness. This is common when children are walking around in wet swimsuits and in boys when they begin to find “themselves.” Topical creams (antibacterial or anti fungal) can be applied but sometimes all that is necessary is a little dab of vaseline or diaper rash cream.
No matter what the cause of painful urination, there are a few things you can do to help:
- The more fluids your child drinks, the more clear their urine is and the less likely it is to hurt.
- If your child is refusing to pee, placing them in the bathtub and encouraging them to pee can help.
The official name for this behavior is pica.
Every child does it to some degree so don’t assume that there’s something wrong with your child just because they like an occasional mudpie.
Pica is most common in children 2-3 years.
Some things to think about (but usually aren’t the cause):
- Lack of nutrients (iron or zinc)
- Developmental problems (autism)
- Normality-Usually this is it!
Why we worry about it:
- Choking risk
- Lead poisoning-Paint (especially in old houses)
- Blocked intestine-Hair or cloth
- Tooth injury-Hard things (rocks)
- Grossness (That’s why parents worry about it, not me so much.)
- Poisoning-Remember 1-800-222-1222 for poison control
What you can do:
1) Tell your child what is ok to eat!
I must say 1000 times per day to my 4 year old (yep, we all deal with the same problems, even pediatricians): “Food and drink are the only things that go in your mouth.”
2) Lock away dangerous items and things your child “craves.”
3) Offer your child a well-balanced diet
4) Don’t stress but monitor as closely as you can especially in those areas where you know you child is likely to start “snacking.”
Sound asleep (or up watching the Olympics-who can sleep with curling on?), you wake up to the earth-shaking, ear-piercing sounds of your child screaming down the hall!
The first night it scares you to death, and then it happens over and over again. Who am I kidding? It scares you to death every time.
What is the difference from a nightmare?
- Occur during non-REM sleep (no dreaming)
- Child is unable to be consoled (no matter what)
- Child goes back to sleep without awakening
- No memory of what happened
Why is there no memory?
- Children are in a deep sleep the whole time
- There are no images to remember
What causes nigtht terrors?
- New environments
- New medications
- Child is over-tired
- You (or the other parent-family history)
What can you do?
- Wait it out (I know this is hard for all of you and particularly hard for some)
- Make sure they are safe (not falling off the bed, etc)
- Do no wake them up (are more confused/scared and harder to get back to sleep)
And finally, work on finding a way to get yourself back to sleep after that adrenaline rush. (You can start by praying that it doesn’t happen again tonight.)
It could go like this:
“Honey, come look at this! What is he doing?”
You walk over to the monitor and see your child doing a couple of quick jerks.
Your child is sick with a fever so you pull them up into bed with you.
Next thing you know, you get a rapid punch to the face or kick in the knee by a child that is completely asleep.
Those rapid “shock-like” jerks are called myoclonus. They can occur anytime but often occur during sleep. They are usually single jerks but 2 or 3 are not concerning.
They tend to increase in activity when a child is sick, especially with fever. This makes them concerning to parents for many reasons:
- Is this happening because they are sick?
- Does this mean that they are really sick?
- You are paying closer attention to them, even during sleep.
- Parents bed share when children are sick.
I have great news! There’s nothing to worry about!
These movements are normal. Everyone does them to some degree.
You should notify your doctor if:
- Jerks happen in series of more than 3
- Jerks happen during the day while the child is awake
- You have associated concerns (especially neurologic or developmental)