The great CBD oil experiment. Sales continue, often through MLM schemes used by anti-vaccine folks to fund their ‘advocacy, as the FDA considers regulation. https://www.npr.org/sections/health-shots/2019/05/31/728370966/as-cbd-oils-become-more-popular-the-fda-is-looking-at-how-they-should-be-regulat
Category: Health Library
Most people are aware that there is a so-called “mystery illness” going around.
A “mystery illness” that is paralyzing some kids.
What’s so mysterious about it?
What is Acute Flaccid Myelitis?
Lots of things are mysterious about acute flaccid myelitis…
We don’t know exactly what causes it, who will get it, why they get it, or how to treat it, etc.
What do we know?
- AFM is not new, although we are seeing more cases lately
- AFM refers to acute (sudden onset) flaccid (droopy or loose muscles) myelitis (inflammation of the spinal cord) and it is a subtype of acute flaccid paralysis
- most cases occur in children, with the ages of affected children ranging from 5 months to 20 years, although some adults have been affected
- these children have a magnetic resonance image (MRI) showing a spinal cord lesion largely restricted to gray matter and spanning one or more vertebral segments
- it is thought that AFM can be caused by viruses (polio, non-polio enteroviruses, West Nile virus, Japanese encephalitis virus, CMV, EBV, adenovirus, etc., environmental toxins, and genetic disorders, and although no common etiology has been found in these recent cases, most experts think that these cases are caused by a neuroinvasive infectious process, likely of viral etiology, including EV-D68 and EV-A71.
- these cases of AFM are not thought to have a post-infectious immune-mediated etiology
- cases are occurring sporadically – after 120 cases in 34 states in 2014, there were only 24 cases in 17 states in 2015, but then 149 cases in 39 states in 2016 and 33 cases in 16 states in 2017. And there have been at least 158 cases in 36 states in 2018, with another 153 cases under investigation.
- outbreaks of EV-D68 and sporadic cases of AFM have also been seen in other countries recently, including Denmark, France, the Netherlands, Spain, Sweden and the United Kingdom (UK)
- most cases occur in the late summer and early fall
- most had symptoms of a preceding viral illness, including respiratory symptoms or diarrhea
- some were unvaccinated
- few were recently vaccinated
- no specific treatments, including steroids, IVIG, plasmapheresis, interferon, and anti-viral medications, have been associated with better outcomes
- some patients have recovered, while many others have persistent paralysis
- there has been at least one death
- some, but not all, were positive for enterovirus D68
- in Colorado this year, 9 of 14 cases were linked to EV-A71 infections
- although there was a national outbreak of EV-D68 in 2014 that coincided with the first AFM cases, we didn’t see the same kind of outbreak in the following years
- AFM isn’t polio, Guillain-Barrésyndrome (GBS), acute disseminated encephalomyelitis (ADEM), or transverse myelitis
- EV-D68 is not new, being first discovered in California in 1962
While that’s a lot of good information, for parents wanting to protect their kids and avoid AFM, there is some key information missing. Same for those wanting to help treat their kids who have or have had AFM.
So although some folks don’t like that it is being called a “mystery illness,” there is still a lot of mystery to it.
But that doesn’t mean that experts aren’t working very hard to take all of the mystery out of AFM.
What Causes Acute Flaccid Myelitis?
Some experts are fairly sure that AFM is caused by an enteroviral infection, to the point that they hope that the CDC focuses work on an enteroviral vaccine.
Which enterovirus though?
At least two different enteroviral infections have been associated with AFM, including EV-D68 and EV-A71.
Why not just make a vaccine to prevent both?
You would first have to make a individual vaccines, before thinking about combining them, and you can’t just make any vaccine you want. If you could, we would have vaccines to protect us against RSV, malaria, HIV, and many other diseases.
Still, since EV-A71 also causes serious outbreaks of hand, foot, and mouth disease in some parts of the world, a vaccine has actually been in development for some time, and two are approved for use in China. That at least means making an EV-A71 vaccine is possible, although we would likely need to make our own.
Why did they make a vaccine for a virus that causes hand, foot, and mouth disease (HFMD)? Because unlike the HFMD that we are used to, which is typically caused by coxsackievirus A16 virus, another enterovirus, when caused by EV-A71, it can be deadly, as we have seen in outbreaks in Asia.
What about an EV-D68 vaccine?
While likely possible, since developing a new vaccine takes a lot of time, we want to be sure that is what is causing the outbreaks.
Do some kids not have either EV-D68 or EV-A71 because it just isn’t detected or because something else is causing them to have AFM? Possibly. One of the biggest issues that is troubling some experts though is that they have not detected these enteroviruses in the spinal cord fluid of many children, as you would expect if the viruses were causing the damage.
But even if these enteroviral infections are the cause, are there other risk factors that make some kids who get these enteroviral infections more predisposed to develop AFM, instead of more typical viral symptoms, like a cold or diarrhea?
And why are we seeing cases now? Did the virus, if that is the cause, just mutate into one that is more virulent?
Hopefully we get some more answers and a way to prevent, treat or cure AFM soon.
Until then, we can make sure we take steps to prevent the known causes of AFM, including polio (get vaccinated) and West Nile virus (use insect repellent), and wash hands properly to help avoid all other viral infections. You also want to get your flu vaccine! The flu can cause Guillain-Barré syndrome, which can also cause AFM.
“…is there any relationship between vaccination status and a developing acute flaccid myelitis? Meaning, are vaccines a risk factor? And the data so far says no, the overwhelming number of children who have gotten AFM have had no recent vaccination of any kind or vaccine exposure. These cases over these years have been happening before flu season and flu vaccination starts, which is one of the questions that comes up, and there hasn’t been any pattern to vaccine exposure of any kind in developing AFM. So far, we have not found a link between the two.”
Benjamin Greenberg, MD on 2018 Podcast on Acute Flaccid Myelitis
And remember, although there are many things we don’t know about AFM, we do know that vaccines do not cause AFM. It would also be great if everyone would get vaccinated so that the CDC and our local health departments could focus on health issues like AFM, instead of still battling measles outbreaks caused by folks who intentionally don’t vaccinate their kids.
What to Know About Acute Flaccid Myelitis
While it might be scary to think that there is a new condition out there that we don’t know everything about, parents should be reassured that experts are actively seeking the cause and a way to both prevent and treat AFM.
More on Acute Flaccid Myelitis
- CDC – Acute Flaccid Myelitis
- CDC – Interim Considerations for Clinical Management of Patients
- CDC – AFM Investigation
- 2018 Podcast on Acute Flaccid Myelitis
- CDC – Transcript for CDC Telebriefing: Update on Acute Flaccid Myelitis (AFM) in the U.S.
- AAP – Acute Flaccid Myelitis in Children
- CDC – Enterovirus D68
- CDC – Enterovirus A71
- Recent Spike in Cases of Acute Flaccid Myelitis
- Clinical Trial – CAPTURE: Collaborative Assessment of Pediatric Transverse Myelitis; Understand, Reveal, Educate
- Clinical Trial – Spinal Cord MRI Research Study for Children, Adolescents, and Young Adults with Myelitis
- Clinical Trial – Understanding Experiences with Vaccination Before and After a Rare Neuro-Immune Disorder
- Transverse Myelitis Association Registry
- A.F.M.- Acute Flaccid Myelitis Awareness & Other Polio-Like Virus Side Effect
- Parents of Children with Polio Like Syndrome / Acute Flaccid Myelitis
- Why health care providers & public health professionals say vaccines are not the cause of recent acute flaccid myelitis (AFM) cases
- Acute flaccid myelitis
- Study – Enterovirus D68 and acute flaccid myelitis-evaluating the evidence for causality.
- The association between acute flaccid myelitis (AFM) and Enterovirus D68 (EV-D68) – what is the evidence for causation?
- Global emergence of enterovirus D68: a systematic review
- Study – Two cases of acute severe flaccid myelitis associated with enterovirus D68 infection in children, Norway, autumn 2014
- Is EV-D68 infection a cause of acute flaccid myelitis in children?
- MMWR – Notes from the Field: Enterovirus A71 Neurologic Disease in Children — Colorado, 2018
- Study – Acute flaccid myelitis: A clinical review of US cases 2012-2015.
- Study – Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008–2015
- Enterovirus 71 infection and vaccines
- A virus-like particle vaccine confers protection against enterovirus D68 lethal challenge in mice.
- Safety, Tolerability and Efficacy of Fluoxetine as an Antiviral for Enterovirus D68 Associated Acute Flaccid Myelitis: A Retrospective Multicenter Cohort Study
- Rhinoviruses and Respiratory Enteroviruses: Not as Simple as ABC.
- Clinical Trial – European Paediatric AFM Associated With EV-D68 Follow-up Study.
- UT Southwestern Transverse Myelitis and Neuromyelitis Optica (TM/NMO) Program
- Johns Hopkins Transverse Myelitis Center
- Boston Children’s Hospital Pediatric Multiple Sclerosis and Related Disorders Program
Updated on December 10, 2018
Got questions about your kids?
Ask the Pediatrician
It you likely won’t be surprised that most other parents have asked the very same questions at some point.
Fortunately, someone has answered them!
- Why do toddlers ask why?
- How do I know if my kid is too sick for school?
- Toddler Night Waking: “Why Does My Baby Wake Up Crying?”
- What and How Much Should My Preschooler Be Eating?
- When Should My Kids Snack?
- How much screen time is OK for my kid(s)?
- My Child Doesn’t Eat the Lunch I Pack! What Do I Do?
- Do Kids Need Omega 3 Fats?
- How Many Calories Does My Teen Need?
- How much of a food allergen does it take to cause a reaction?
- Does My Child Need A Supplement?
- Is Fish Healthy for My Child?
- Is a Low-Carb Diet Safe for Kids?
- Does My Child Need a Gluten Free Diet?
- What and How Much Should My Preschooler Be Eating?
- When Is My Child Ready for an Adult Seat Belt?
- Is screen time bad for kids’ eyes?
- At what age should a child get a cell phone?
- Why do ACIP recommendations not always agree with package inserts?
- Why are vaccines generally not given to infants younger than 6 weeks of age in the U.S.?
- Is peanut allergy a contraindication to any vaccine?
- Should we be concerned that my daughter has a red spot after I elbowed her in the eye?
- Does Not Wearing Glasses Worsen Vision?
- My child says glasses doesn’t help him. Should we insist he wears them?
- Why do some girls get bullied?
- Does my son really have to avoid milk and wheat?
- What causes frequent nosebleeds?
- How long does cat dander remain in a home after the cats are gone?
- What do I do if I have an allergy but all my skin tests are negative?
- What options are available for allergy-proof coverings?
- Why do I get hives when it’s cold?
- Could I have a mental health problem?
- Why do my mosquito bites blister and scar?
- My teenage son wants to weight train. Should I let him?
- Do I need to keep my son home if he has pinkeye?
- Is a temporal or ear thermometer better for taking a 2-year-old’s temperature?
- Can infants get strep throat?
- What does transgender mean?
- How do I mix and serve infant formula for my baby?
- How long should my child ride rear-facing?
- What Can I Do to Keep My Child from Choking?
- What causes swimmers ear?
- What is POTS and why does it cause fatigue?
- Why does craniosynostosis cause such an abnormal head shape?
- Should My Teen Do Breast Self-Exams?
- Is shaving my body OK? I keep getting razor burn in my crotch from it…
- I shaved my pubic hair at the base of my penis and most of the skin has become a crusty rash. This is now happening on my penis. I’ve never had sexual intercourse, so I’m not sure what the problem is!
- What causes dandruff?
- Should I use a home kit to drug test my teen?
- I’m 13 and ALL of my friends have hit puberty except me and it’s really embarrassing! When will I?!
- Is it safe to use Q-tips to clean my ears?
- I’m 14 and I have enlarged breasts. Is it gynecomastia? Can it be cured without surgery?
- Why have I been losing my appetite? I’m not sick or anything, I eat, but not as much as I usually do.
- What causes acne?
- Who gets melanoma?
- What are the warning signs of an unhealthy body image?
- What do you do if a child has a seizure?
- What do I do if I think my teen has a problem with drugs?
- Which heart screenings are necessary for athletes?
- What do I do about all these ingrown hairs?
- When should I take my child to the dentist for the first check-up?
- When will I start my period?
- How often should I change my pad or tampon?
- What are the types of emergency birth control pills?
- Is it normal for kids to walk on their tiptoes?
- Home much homework is too much?
- When should I get help for my child’s stuttering?
- What are the signs of a swallowing or feeding disorder?
- What is dyscalculia?
- What is dysgraphia?
- What is dyspraxia?
- What is a language processing disorder?
- Could my child have a learning disability?
- What do I do if my baby’s newborn screen test is positive?
- What are the ABCDEs of melanoma?
- Why are my hands so sweaty?
- How can I teach my kids to share more?
- Is it too early to begin reading to my 6-month-old?
Find your answers?
Of course, you should always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Still, these answers can be helpful, especially for non-urgent problems.
More on Ask the Pediatrician
- Ask the Experts about Vaccines
- AAP – Ask the Pediatrician
- Children’s National Q & A Forum
- Ask an Ophthalmologist
- Ask the Allergist
- Young Men’s Health
- Epilepsy FAQ
- Ask a Doctor about Eczema
- Ask the Diabetes Team
- Go Ask Alice!
- American Academy of Pediatric Dentistry
- ACOG Patient Education FAQs
- Learning Disabilities Association of America
- Ask an Expert about Newborn Screening
Do your kids ever complain about problems with their feet?
If not, they probably will at some point…
Common Pediatric Foot Problems
Fortunately, not all of those complaints will be caused by real problems.
Some will be though, so it is important to learn about common pediatric foot conditions (comprehensive information is provided in the links below), including:
- ankle sprains – it is typically good news to hear that your child only has an ankle sprain and that nothing is broken, but that doesn’t always mean a quick recovery. A moderate or severe ankle sprain can mean a recovery plan that takes up to 6 to 12 weeks! Remember the RICE protocal (Rest, Ice, Compression, and Elevation) and an age appropriate dose of a nonsteroidal anti-inflammatory drug, like ibuprofen or naproxen, if your child has a mild sprain, and see your pediatrician if your child sprains their ankle and has severe pain, can’t bear weight on their foot, or isn’t getting better.
- in-toeing – unless a baby’s foot is rigid (a sign of club foot), in-toeing is usually normal and doesn’t require treatment. That’s despite what you may hear from grandparents who swear up and down that they remember wearing special shoes when they had in-toeing. While they probably did, that isn’t routinely done anymore, as most kids grow out of their in-toeing without treatment.
- out-toeing – also usually normal and doesn’t require treatment with special shoes or casting, like they did “in the old days.”
- athlete’s foot – common in older teens, who can have dry, scaling skin on their feet that itches or burns, especially between their toes, athlete’s foot (tinea pedis) is less common in younger children who are more likely to have JPD. Athlete’s foot can usually be treated with an over-the-counter antifungal medication. If it doesn’t go away after a few weeks, it is time to think of another diagnosis, consider if your child might have a secondary bacterial infection, or if a prescription oral medication might be necessary.
- fungal nail infections – in addition to athlete’s foot, kids can also get a fungal infection in their toe nails (onychomycosis). If mild, a topical antifungal medication may be all that is needed to treat your child’s fungal nail infection, but oral antifungal drugs are usually needed.
- plantar warts – sometimes confused with corns, plantar warts are common in kids and can be treated with over-the-counter remedies when they become bothersome.
- blisters – if your kids are active, or if they are relatively inactive, but you end up on a long walk on a vacation, they will likely end up with a friction blister on their feet at some point. What do you do? Apply a hydrocolloid gel bandage (readily available over-the-counter) to the blister, draining large blisters if necessary.
- ingrown toenails – common in teens who pick at or trim their toenails too short, ingrown toenails (onychocryptosis) can become really bothersome when they become infected. If soaks and antibiotics don’t help, the ingrown toenail may need to be surgically removed. Make sure your kids wear shoes that fit properly and trim their toenails straight across to prevent them from getting ingrown toenails.
- heel pain – many active pre-teens and teenagers have pain in their heels. It is often caused by Sever disease (think of it like growing pains instead of a “disease”) and can be treated with heel pads or cups, icing after sports, stretching exercises, and symptomatic care.
- flat feet – while parents often complain that their kids have flat feet, most have flexible flat feet and don’t need treatment. On the other hand, some rigid flat feet, which is more rare, and might require treatment. Does your child have an arch when they stand on their tip toes?
- overpronation – does it seem like your child’s ankles bend inward when he stands or walks, even to the point that he wears out the inside parts of his shoes quicker than the outside? While it can be normal, if it is leading to foot, ankle, knee, or back pain, then your child likely needs arch supports for his shoes (pronation insoles) or custom made orthotics.
- toe walking – while normal before age two to three years, children who continue to toe walk after age three to five years, especially if they always toe walk or refuse to walk in a normal heel-to-toe pattern should have an evaluation and will likely need therapy to help them walk properly.
- bunions – can kids really get bunions? They can, presenting with a big bump at the base of their big toe (juvenile hallux valgus), which will turn toward the second toe.
- bunionette – when they occur at the base of your child’s little toe, the painful bump is called a bunionette.
- corns and calluses – often confused with a plantar wart, you can often tell the difference between a corn or callus and a wart because warts disrupt normal skin lines and might have little black ‘seeds’ inside them (broken blood vessels). If you still aren’t sure, just remember that warts are more common than corns and calluses in kids.
- curly toe – kids with curly toes have underlapping toes and while it often doesn’t cause symptoms, when it does, surgery can fix it.
- juvenile plantar dermatosis – JPD is often confused with athlete’s foot, as they have similar symptoms – red, scaling skin on the feet and toes. JPD, which is also called sweaty socks syndrome, occurs in younger kids and spares the toe webs though, and it is not caused by a fungus. Wearing cotton socks, and changing them frequently, shoes that fit well, and applying a moisturizer and steroid cream can treat JPD.
- foot odor – does your child have smelly feet? While you likely want to blame a fungus, stinky feet are usually caused by a bacterial infection, an infection that might cause a very mild rash on the bottom of your child’s feet that can go unnoticed – and smelly feet. It can be treated with a topical antibiotic ointment, not letting shoes get wet, and changing sweaty socks often.
- sweaty feet – a lot of kids have sweaty feet and unfortunately, that can lead to some of the problems listed above. Some have really sweaty feet (plantar hyperhidrosis) though, to the point that they have to change their socks several times a day. It might also help to buy super absorbent insoles for all of their shoes, moisture wicking socks (Drymax and Copper sole socks, etc.), absorbent foot powder, and mesh type shoes.
Need extra help with your child’s feet?
See your pediatrician. Depending on the issue, a pediatric dermatologist, pediatric orthopedic surgeon, or a podiatrist with expertise in pediatric conditions might also be helpful.
What to Know About Common Pediatric Foot Problems
From athlete’s foot and blisters to plantar warts and sweaty feet, there are many foot problems that parents should learn about and hopefully learn to prevent.
More on Common Pediatric Foot Problems
- Out-toeing / In-toeing
- Pigeon toed or bowlegged – should I be worried?
- Flat Feet
- Flexible Flatfoot in Children
- Fungal nail infections
- Athlete’s foot
- Athlete’s foot: How to prevent
- Juvenile plantar dermatosis
- Dermatologists share tips for treating corns and calluses
- Wishing Away Warts
- What warts look like
- Heel Pain and Sever’s Disease
- Over-Pronation: When Is It Abnormal?
- Ingrown Toenails
- Toe Walking
- Friction blister
- Corns and Calluses
- Sprained Ankle
- ‘It’s only a sprain.’ But what does that really mean?
- Foot and Ankle Rehabilitation Exercises
- Pitted keratolysis (smelly feet)
- Curly Toe
- Cracked heel
- Pediatric Foot Deformities: An Overview
We have been warning parents about high-powered magnets since 2007!
That’s when the first complaints started coming into the Consumer Product Safety Commission about kids swallowing small magnets that were falling out of toys or that were actually sold as toys to create patterns and build shapes.
Remember Buckyballs and Buckycubes?
They issued another magnet safety alert in 2011, when they found that incidents of children ingesting these high-powered magnets were increasing each year, with reports of 22 incidents between 2007 and 2009, including 11 of which required surgical removal of the magnets.
Next, in 2012, we heard about a 3-year-old who required emergency surgery after swallowing 37 magnets!
High-Powered Magnet Dangers
Unfortunately, when kids swallow more than one of the small, 5mm magnets, they can attract each other through the walls of the child’s intestine. And this is what happened to the little girl who swallowed 37 Buckyballs. She required emergency surgery to repair perforations in her stomach and intestines.
This led to a recall of Buckyballs, but surprisingly, their importer, Maxfield & Oberton LLC, refused to participate in the recall, even though the CPSC “has received 54 reports of children and teens ingesting this product, with 53 of these requiring medical interventions.”
Another death, a 19-month-old girl and an estimated 2,900 emergency room-treated injuries between 2009 and 2013 led the CPSC to create a new safety rule for high-powered magnet sets.
Unfortunately, a Federal Court put aside that safety rule, so that you can still buy these dangerous high-powdered magnets.
And many of you likely did, as Christmas gifts.
And some of you have likely already been to the ER after a child in your home swallowed those high-powered magnets.
Be warned. If you have kids in the house, those “Mashable, Smashable, Rollable, Buildable Magnets” could end up in their mouth and getting swallowed.
Remember, as we have been warning folks for at least 10 years, even though they are sold as “Magnetic Toys,” these high-powered magnets are not good choices for kids.
What to Know About the Dangers of High-Powered Magnets
High-powered magnets don’t make good toys for kids. Understand the risks if you have them in your home and be sure to seek immediate medical attention if your child swallows a magnet.
More on the Dangers of High-Powered Magnets
- “Toy” Magnets Are Dangerous for Children
- CPSC Warns High-Powered Magnets and Children Make a Deadly Mix
- CPSC – Magnets Information Center
- CPSC Issues Decision on Zen Magnets
- Popular magnets pose risk if swallowed
- CDC – Gastrointestinal Injuries from Magnet Ingestion in Children — United States, 2003–2006
- Study – Attraction Problems Following Magnet Ingestion
- Study – Multiple magnet ingestion as a source of severe gastrointestinal complications requiring surgical intervention.
Did you know that just because your younger child is pulling at their ears, it doesn’t automatically mean that they have an ear infection?
It could be teething, an over-tired infant or toddler, or a kid with a cold and their ears are popping because of congestion.
Understanding common, and some not so common symptoms of pediatric diseases can help make sure that your kids get diagnosed and treated quickly.
Symptoms of Classic Pediatric Diseases
Most parents are familiar with the more classic pediatric diseases and the signs and symptoms that accompany them, such as:
- Appendicitis – classically, it starts with pain near the belly button, which quickly worsens and moves to the lower right side of your child’s abdomen. Appendicitis is not always classic though
- Croup – often starts in the middle of the night with a seal bark cough, heavy breathing that sounds like wheezing, and a hoarse voice
- Diabetes – type 1 diabetes is classically associated with polydipsia (drinking a lot), polyuria (frequently urinating large amounts), and weight loss
- Ear infection – in addition to ear pain, fussiness, or tugging at their ears, kids with an ear infection will usually have cold symptoms, or at least might have had a recent cold, with a cough and runny nose
- Fifth disease – red cheeks that appear to be slapped followed by a pink lacy rash on a child’s arms and legs that can linger for weeks
- Hand, foot, and mouth disease – caused by the coxsackievirus A16 virus, kids with HFMD classically have ulcers in their mouth and little red blisters on their hands and feet. They might also have a fever and a rash on their buttocks and legs.
- Hives – hives or whelps are raised, red or pink areas on your child’s skin that come and go, moving around over a period of three to four hours and are a sign of an allergic reaction. Unfortunately, unless your child is taking medicine or just eat something, it can be hard to find the allergic trigger. You often don’t need to though, as hives can also just be triggered by viral infections and might not come back.
- Impetigo – honey colored crusted areas on your child’s skin that are a sign of a bacterial infection
- Ringworm – a fungal infection that can appear on a child’s skin (tinea corporis), feet (tinea pedis), groin (tinea cruris), nails (tinea unguium), or scalp (tinea capitis)
- Roseola – another viral infection, this one is caused by human herpesvirus 6 (HHV-6) and 7 and causes a high fever for three or four days, and then, as the fever breaks, your child breaks out in a pinkish rash. The rash starts on their trunk, spreads to their arms and legs, and is gone in a few days.
- Swimmer’s ear – the tricky part about recognizing swimmer’s ear is that you can get it anytime you get water in your ear, not just after swimming, leading to pain of the outer ear, especially when you push or tug on it.
Symptoms of Uncommon Pediatric Diseases
Although not necessarily rare, it is often uncommon for the average parent, and some pediatricians, to be familiar with all of the following conditions unless they have already been affected by them.
Why should you know about them?
Some are medical emergencies. Missing them could lead to a delay in seeking treatment.
Others, while they might not be emergencies, often lead parents to seek treatment, but it might not necessarily be the right treatment if someone doesn’t recognize what is truly going on with your child.
- Acanthosis nigricans – dark thickened (velvety textured) skin often found on the back of an overweight teen’s neck, and sometimes in their armpits and other skin folds, and which can be a sign of type 2 diabetes
- Anaphylaxis – while a severe allergic reaction like anaphylaxis is not easy to miss, getting proper treatment is sometimes difficult. This life-threatening reaction requires an epinephrine injection as soon as possible, something that some parents and even some emergency rooms seem hesitant to do.
- Bell’s Palsy – children with Bell’s palsy develop a sudden weakness or paralysis of the muscles of one side of their face. Fortunately, the symptoms usually begin to resolve in a few weeks.
- Breath holding spells – a young child having a breath holding spell will actually pass out! While it sounds scary, since they follow a typical pattern, either the child is crying forcibly (cyanotic breath holding spell) or something painful happened suddenly (pallid breath holding spell), and they quickly wake up and are fine, you hopefully won’t panic if you ever see one.
- Cat scratch disease – after a bite or scratch from an infected cat or kitten, a child will develop a few lesions at the scratch site, but will also develop enlarged lymph nodes nearby – typically their armpit or neck if they were scratched on the arm.
- Cyclic vomiting syndrome – possibly related to migraines, children with cyclic vomiting syndrome have repeated episodes of intense nausea and vomiting, sometimes leading to dehydration, every few weeks or months
- Diabetes insipidus – like type 1 diabetes, kids with diabetes insipidus urinate a lot and drink a lot, but it has nothing to do with their blood sugar. It can follow a head injury or problem with their kidneys.
- Encopresis – kids with encopresis have soiling accidents, sometimes leading parents to think that they have diarrhea. Instead, they are severely constipated and have small amounts of liquidy stool involuntarily leaking into their underwear after getting passed large amounts of impacted stool.
- Erythema multiforme minor – triggered by infections and sometimes medications, kids with EM have a rash that looks like hives, but instead of going away, they just keep getting more spots, some of which look like target lesions. The severe form of EM, erythema multiforme major is fortunately rare.
- Geographic tongue – a curiosity more than a condition, children with geographic tongue have bald areas on their tongue where the papilla have been lost (temporarily). The name comes from the fact that the shapes of the bald areas vary in size and shape and they move around. They are not painful, although parents typically don’t notice them until they look in their child’s mouth when they complain of a sore throat or other problem.
- Henoch-Schonlein Purpura (HSP) – episodes of HSP typically follow an upper respiratory tract infection, when kids develop a rash (palpable pururpa), stomach aches, arthritis (joint swelling and pain), and more rarely, kidney problems. The rash is distinctive – red dots (petechiae) and a hive-like rash that looks like bruises.
- Hemolytic Uremic Syndrome (HUS) – follows a diarrheal illness with E. coli, in which toxin from the bacteria causes bleeding (from low platelets) and anemia (destruction of red blood cells) and can lead to kidney damage.
- Intussusception – colicky abdominal pain (severe pain that comes and goes) and loose stools that are filled with blood and mucous (red currant jelly stools) in young kids, typically between the ages of three months and three years
- Kawasaki disease – it is important to recognize when a child might have Kawasaki disease, because early treatment might help prevent serious heart complications from developing. The initial signs and symptoms of Kawasaki disease can include a prolonged fever (more than five days), swollen lymph glands, pink eye (without discharge), rash, strawberry tongue, irritability, swelling of hands and feet, red and cracked lips, and as the fever goes away, skin peeling.
- Nephrotic syndrome – kids with nephrotic syndrome have swelling (edema), around their eyes, on their legs, and even their belly. All of the swelling causes them to quickly gain weight. Because, at first, the swelling is worse in the morning and gets better as your child is up and about, it might be mistaken for other things that cause swelling, like eye allergies. Nephrotic syndrome won’t get better with eye drops though.
- Night terrors – most common in preschoolers and younger school age children, kids with night terrors ‘wake up’ in the early part of the night screaming and are confused and impossible to console, because they are really still asleep. The episodes are not remembered the next morning and are often triggered when kids are off their schedule or under extra stress.
- Nursemaid’s elbow – you are walking with your toddler and all of a sudden he gets mad, drops to the ground while you are holding his hand, and then he refuses to move his arm or bend his elbow. Did you break his arm? It’s probably a radial head subluxation, which your pediatrician can usually easily reduce.
- Obstructive sleep apnea – although many kids might snore normally, with obstructive sleep apnea, the snoring will be loud, with pauses, gasps, and snorts that might wake your child up or at least disturb their sleep.
- PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections is characterized by OCD and/or tics that appear or suddenly worsen after a strep infection.
- Peritonsillar abscess – a complication of tonsillitis, it can cause fever, severe throat pain, drooling, a muffled voice (hot potato voice), and swelling on the side of one tonsil, pushing the uvula towards the other side
- Pica – while many younger kids put things in their mouth, kids with pica crave and eat all of those non-food things. Since it can be a sign of iron-deficiency, talk to your pediatrician if you think that your child might have pica.
- Pityriasis rosea – kids with pityriasis rosea have a rash that starts with a herald patch (looks like a ringworm) and is then followed by a lot of small, oval shaped red or pink patches with scale on their trunk. The rash, which may be a little itchy, can last for up to 6-12 weeks.
- POTS – teens with Postural Orthostatic Tachycardia Syndrome have dizziness, fatigue, headaches, nausea, difficulty concentrating and other symptoms related to alterations or dysfunction in the autonomic nervous system (dysautonomia).
- Pyloric stenosis – since so many infants spit up, it is not uncommon for the parents and pediatricians to sometimes delay thinking about pyloric stenosis when a baby has it. Unlike reflux or a stomach virus, with pyloric stenosis, because their pylorus muscle becomes enlarged, no food or liquid is able to leave their stomach and they eventually have projectile vomiting of everything they try to eat or drink. It is most common in babies who are about three to five weeks old.
- Scalded skin syndrome – unlike typical bacterial skin infections, with scalded skin syndrome, exotoxins that certain Staphylococcus aureus bacteria cause the skin to blister and appear burned, with eventual skin peeling
- Stevens-Johnson Syndrome – a rare skin reaction that can be triggered by medications, beginning with flu like symptoms, but then progressing to a blistering rash that includes their mouth and eyes.
- Testicular torsion – if one of the testicles twists around the spermatic cord, it can cut off blood flow and quickly lead to permanent damage. Sudden, severe pain and swelling often make it easy to recognize this medical emergency, but sometimes the pain comes on more slowly or the pain is dismissed as happening from trauma, epididymitis, or torsion of the appendix testis.
- Toxic synovitis – typically following a viral infection, kids with toxic synovitis have hip pain and limping for a few days, but otherwise seem well, without high fever or other symptoms
- Vocal cord dysfunction – often misdiagnosed as asthma, especially exercise induced asthma, and other things, kids with vocal cord dysfunction often have episodes of repeated shortness of breath, chest tightness, wheezing, and coughing – just like asthma. They don’t improve though, even as more asthma medicines are added, which should be a red flag that they don’t have asthma and could have vocal cord dysfunction instead.
- Volvulus – a volvulus occurs when the intestines twists on itself, cutting off blood blow. In addition to severe abdominal pain, these kids often having vomiting – typically of a green, bile looking material (bilious vomiting). Green vomitus can also be a sign of other intestinal obstructions, but all would be a medical emergency.
Is knowing about these conditions always helpful?
No, especially if you don’t know what a ‘seal bark’ or ‘hot potato voice’ sounds like or what ‘red currant jelly’ looks like, but it likely shouldn’t hurt to get a little more educated about the diseases that could be causing your child’s symptoms.
What to Know About Recognizing Symptoms of Pediatric Disease
Having the internet and access to Google doesn’t make you a doctor. Get real medical advice if you think that your child is sick and has symptoms that have you concerned. It does help to know which symptoms to be concerned about though.
More on Recognizing Symptoms of Pediatric Disease
- Study – Common Pediatric Medical Emergencies in Office Practice
- CDC – Children (Ages 0-3) – Diseases & Conditions
- CDC – Children (Ages 4-11) – Diseases & Conditions
- CDC – Children (Ages 12-19) – Diseases & Conditions
- AAP – 10 Common Childhood Illnesses and Their Treatments
- AAP – Pediatric Conditions A to Z
- Pediatric Orthopedic Conditions
- Children & Teens with Kidney Disease
- Childhood Heart Conditions
Molluscum contagiosum is a very common childhood skin rash, that surprisingly, few parents seem to have ever heard of.
While most parents have likely have heard of eczema, ringworm, and impetigo, a diagnosis of molluscum might leave them with their head scratching. Hopefully their kids won’t be scratching too.
Molluscum is contagious!
Symptoms of Molluscum Contagiosum
Molluscum contagiosum lesions are typically small and dome shaped, with a small dimple in their center. Although often flesh colored, they can also be pink.
They are usually found alone or grouped on a child’s chest or back, arm pit, or around the skin folds of their elbow and knees.
For many children, molluscum don’t cause any symptoms and the rash is simply a cosmetic problem. Others can get redness and scaling on the skin around the molluscum rash, and it may be itchy.
Another characteristic is that molluscum will sometimes have a plug of cheesy material coming out of the central part of the lesion.
Spotting Molluscum Contagiosum
The diagnosis of molluscum is usually made based on their classic appearance.
The diagnosis can be confusing at first though, when the molluscum are still very small. It may take a few weeks for the lesions to grow before they look like more typical molluscum lesions.
Molluscum might also be confused with other rashes if they are red and inflamed when you go see your pediatrician, or if there is a lot of redness around the rash. That might make your pediatrician think that your child has a small abscess or simple eczema.
Getting Rid of Molluscum Contagiosum
Since molluscum usually goes away in about six to nine months on its own, some pediatricians advocate not treating it. Keep in mind that it can sometimes last for two to four years and may spread aggressively, which is why others do recommend treating molluscum with:
- Direct removal with a curette
- Cryosurgery – freezing
- Cantharidin – a blistering agent
- Aldara cream (Imiquimod) – also used for genital warts, although they are not related to molluscum
- Retin A cream (Tretinoin) – also used for acne
All of these treatments have their shortcomings though.
Direct removal and cryosurgery are painful. Cantharidin can cause large blisters. Aldara is expensive. And Retin A doesn’t always work well when used by itself. Also, both Aldara and Retin A can be very irritating to the normal skin that surrounds the molluscum rash.
More About Molluscum Contagiosum
So what should you do about your child’s molluscum?
Talk with your pediatrician or a pediatric dermatologist about your options, which might include:
- Leaving the molluscum alone, especially if your child has already had them for several months and they are not spreading. Just avoid sharing towels and skin-to-skin contact with others, because they are contagious. It is not a reason to stay out of school or daycare though.
- Trying direct removal with a curette or cryosurgery if your child only has a few lesions. Although it can be painful, your pediatrician can consider using a topical anesthetic.
- Using cantharidin if your child doesn’t have a lot of lesions. It is not FDA approved in the United States though, so not all doctors have it, and it can sometimes produce large blisters.
- Using Aldara cream or Retin A cream – either alone or together on alternate days.
Most importantly, if you do treat your child’s molluscum, watch for new lesions during treatment. They are contagious and start spreading the infection again, even if the initial treatment was successful. And molluscum has a very long incubation period – up to about two months!
Other things to know include that:
- Molluscum contagiosum is caused by a double-stranded DNA poxvirus.
- Molluscum can be spread by direct contact with an infected person, touching contaminated objects (such as towels, toys, or clothing), and on a child when they scratch a lesion and then scratch other areas of their skin (autoinoculation). So encourage your child to not pick at them.
- Molluscum can grow aggressively in children who have a weakened immune system.
- Molluscum can be a sexually transmitted infection in older teens and adults. It is so common in young children though, that unless there are other signs or suspicions, it is usually not considered a sign of abuse, even if you find an isolated lesion in the anogenital area.
Also keep in mind that a pediatric dermatologist can be helpful if your child has molluscum that isn’t responding to standard treatments.
What to Know About Molluscum Contagiosum
Molluscum contagiosum is a very common viral infection that can cause a skin rash in children. Although difficult to treat, it does typically go away on its own – eventually.
More Information on Molluscum Contagiosum
- CDC – Molluscum Contagiosum
- AAP – Molluscum Contagiosum
- NHS – Molluscum contagiosum
- Molluscum Contagiosum
- Molluscum contagiosum
- Molluscum Patient Perspectives
- Molluscum contagiosum: Overview
- What is Molluscum Contagiosum?
- Review – Molluscum contagiosum: an update.
- Common Conditions That Mimic Findings of Sexual Abuse