Molluscum Contagiosum and Kids- What to Do?

Welcome back to Medicine Mondays.

Each Monday I'll post answers to questions I acquired. If you have a question please feel free to send me an email or leave me a comment. I welcome every comment and hope to help answer some questions. Just remember that my advice is not a substitute for a physical exam and medical advice that your family doctor can provide.

Today we're talking about Molluscum Contagiosum.

I received this question from a fellow reader:

My daughter was just diagnosed with Molluscum. Daycare is freaking out because they don’t know what it is (I’ve never heard of it either). They are asking me to get a note from the pediatrician on what it is so that they can explain it to the other parents... is it only spreadable when the warts are “an open wound” or is it spreadable all the time?

Molluscum Contagiosum Virus (MCV) is one of those annoying little skin infections that kids get. eMedicine has a great very indepth article that outlines the varies aspects of MCV infection. Here a brief exerpt.

MCV causes characteristic skin lesions consisting of single or, more often, multiple, rounded, dome-shaped, pink, waxy papules 2-5 mm (rarely up to 1 cm) in diameter. The papules are umbilicated and contain a caseous plug. MCV is an unclassified member of the Poxviridae family

MC is most common in children who become infected through direct skin-to-skin contact or indirect skin contact with fomites, such as bath towels, sponges, and gymnasium equipment. Lesions typically occur on the chest, arms, trunk, legs, and face. Hundreds of lesions may develop in intertriginous areas, such as the axillae and intercrural region. Lesions may rarely occur on the mucous membranes of the lip, tongue, and buccal mucosa. The palms are spared. Patients with eczema may develop large numbers of lesions.

MCV may be inoculated along a line of minor skin trauma, resulting in lesions arranged in a linear pattern- a process that is termed autoinoculation.

Treatment is generally avoided as most healthy children will resolve their lesions in 6-9 months. Some cases may last for years. If the lesions are spreading particularly fast or are becoming infected you may want to talk with your physician regarding special therapy. For most children freezing or burning off the lesions cause more harm and pain than do the original lesions. But this an options that many parents elect.

For a few individuals the Molluscum lesions may indicate that a person is immunodeficient or immunocompromised. Take your child to the doctor if your child has a particularly bad case of Molluscum and doesn't seem to be healing from them.

Other that that there's nothing much you can do. Except ignore it- which is what I do. That's my little boy in the picture! Oh and I send these kids back to daycare. It's unrealistic to keep them out.

Take Time to Play

This weekend I was talking to my husband who has up and left me...for the week. He's away on business and I'm wallowing in the sudden despair of life as a single working parent of three small children.

So I was chatting on along and I said. "Now that you're out of town I could take this opportunity to redo the kids entire room. Get it all cleaned up. (There was a pause) "Or not. I could just lounge around, get the train tracks out and just play with the kids."

And that's just what I did. It was a delightful morning.

Making the Right Medical Decisions for Your Child

Making the right medical decisions for your child isn't always simple or clear cut. Yet we as parents are faced with these decisions everyday. And as a pediatrician I'm also faced with answering these questions. Just today I spent extra time with a family. They were having a hard time making a decision for their child. Finally I just printed out some info and told them to go think about it. I trust that they will research the topic and come back with more questions and then we can really get down to understanding what needs to be done.

As parents we presumably want the very best for our child and in this day and age there's a lot of doctor mistrust. Gone are the days of paternalistic medicine -where what the doctor say goes. Now, everyone has an opinion from guy at the walk- in Urgent Care site to Cousin Betty who is a nurse and her daughter the dental assistant. Between all the varied opinions it can be hard to sort it all out and make a well informed decision.

Make sure you gather all the information available and make the decision that you feel is the best for him, not just the one that makes you feel less squeamish.

This is what I recommend-

• Know every step of what is being done. This ranges from getting vaccines to antibiotics.

• Try not to get caught up in the anecdotal data that is floating around. "I once knew a friend whose brother's sister got sick that way!" isn't substantial enough evidence to avoid a procedure.

• Don't try to assume that your doctor will know everything. If you really need the opinion of a specialist then make sure you get to talk with one.

• If it doesn't seem right say so.

• Do your research.
  

• Ask your friends.

• Keep an open mind.

• Ask the right questions such as:
  

1. What would be the consequence of not getting the procedure/treatment?
2. Is this the standard of care?
   
3. Would the results change our management?
   
4. Are there other alternatives?
5. What are the risks?
   
6. Can I have a second opinion?
   

When Your Child Gets Iron Deficiency

Hi Everyone,

Welcome back to Medicine Mondays.

Each Monday I'll post the questions that I have collected over the week. If you have a question please feel free to send me an email or leave me a comment. I welcome every comment and hope to help answer some questions. Just remember that my advice is not a substitute for a physical exam and medical advice that your family doctor can provide.

Today I'm going to talk about my youngest son who was just diagnosed with iron-deficiency Anemia. I wasn't too surprised given that he'd been looking really pale but I have to say I was surprised that it was as low as it as. I thought we were doing all the right things such as eating high iron foods such as red meat, beans and raisins but it wasn't enough.

If you need to know the what and why's of iron deficiency then MedlinePlus has a good synopsis:

Iron deficiency anemia is the most common form of anemia. Iron is an essential part of hemoglobin, the oxygen-carrying protein in blood. Iron comes from the diet and by recycling iron from old red blood cells.

Babies are born with about 500 milligrams (mg) of iron in their bodies. By the time they reach adulthood they need to have about 5,000 mg.

Children need to absorb an average of 1 mg per day of iron to keep up with the needs of their growing bodies. Since children only absorb about 10% of the iron they eat, most children need to ingest 8-10 mg of iron per day. Breast-fed babies need less, because iron is absorbed 3 times better when it is in breast milk.

An iron-poor diet is a common cause of iron deficiency. Drinking too much cow's milk is a common cause of iron deficiency in young children because cow’s milk contains little iron and can get in the way of iron absorption. Cow's milk also can cause problems in the intestine that lead to blood loss and increased risk of anemia.

A common time for iron deficiency is between 9 - 24 months old. All babies should have a screening test for iron deficiency at this age. Babies born prematurely may need to be tested earlier. The adolescent growth spurt is another high-risk period.

Prevention is the best way to avoid any iron deficiency. Here's a list that includes some of the good, better and best sources of iron in foods.

• Good sources include tuna, oatmeal, apricots, raisins, spinach, kale, greens, and prunes.
• Better sources include eggs, meat, fish, chicken, turkey, soybeans, dried beans, peanut butter, peas, lentils, and molasses.
• The best sources are breast milk (the iron is very easily used by the child), formula with iron, infant cereals, other iron-fortified cereals, liver, and prune juice.

We now have him on an iron supplementation (I put it in his juice to help mellow the flavor) and I'm increasing his iron in his diet. We gave him Cream of Wheat this weekend and added raisins to boot. It's going to take a couple of months to get his iron levels up and then even longer to replace his iron stores. But if I'm consistent he should recover nicely and have no long term consequences such as decreased alertness, attention span and learning.

If your child has iron deficiency anemia, leave me a comment. I'd love to hear how you got their iron levels up!