School is almost out and for most kids the summer will be full of outdoor activities. Hikes, camping trips and simple outdoor play will be at the top of many lists. To avoid contact and a reaction from poison ivy, parents should teach their kids what it looks like and also what it does. We talked to Dr. Christie Michael, an allergist at Le Bonheur Children’s Hospital to learn more. Here's what she had to say:

"Not everyone reacts to poison ivy. However, just because a reaction didn’t occur in the past doesn’t mean it won’t in the future. Prevention is best so kids should learn what the leaves look like. If your child is exposed, bathe him or her immediately and add 3/4 cup of bleach to a tub of bath water. Once lesions develop, use topical benadryl or steroid cream such as cortisone. Avoid scratching but if itching is severe, an oral antihistamine can be given. For bad reactions, visit your pediatrician who might prescribe a short course of oral steroids."

With pool season right around the corner, we thought it would be a good time to ask about swimmer's ear, a popular discussion topic among parents this time of year. 

According to the American Academy of Pediatrics, swimmer's ear is an inflammation of the external ear canal. Children get swimmer's ear when water gets into the ear and doesn't properly drain.

"Youngsters with this condition will com­plain of itching or pain in the ear, the latter particularly when the head or the ear itself is moved," said the AAP. "As the canal swells, hearing will decrease. The infected ear may ooze yel­lowish pus."

We asked Le Bonheur Children's Chief of Otolaryngology (ENT) Dr. Jerome Thompson about the common summer condition, and the best way to get rid of it. Thompson advised pouring small amounts of rubbing alcohol into a child's ear to remedy swimmer's ear.

"Sometimes a 50/50 of rubbing alcohol and white vinegar solution is also good," he said. "As always, if pain or complaints persist, a visit to the pediatrician is probably needed."

It is important to prepare your child for the MRI process by communicating with age- appropriate, child-friendly words. Before you prepare your child, you need to learn the correct information. We talked to Lauren Geyer, certified child life specialist at Le Bonheur Children's Hospital, who works with families in our Radiology Department. Here's what she had to say.

"MRIs are tests used to detect disease and abnormalities in the body.  Surgery can be accurately directed once the doctor views the results of the scan. An MRI can take up to an hour, and for most children, it’s hard to be still for this long. That’s why you should discuss with your child’s doctor her ability to remain still and calm during the MRI process .

Once you and your doctor have made a plan, it is important to tell your child what to expect.  Use positive words that children will understand. A good example would be to tell them that special pictures will be taken with a “big, doughnut-like” camera so the doctor can learn more about how their body is working. If your child is going to have an MRI without “sleepy medicine” or anesthesia, assure him or her nothing on the camera will touch or hurt and that you will remain close by. Your child will be comfortable with a blanket. There may be a piece of plastic that lays over your child; explain that this helps the camera know what they are taking pictures of.

Once your child is comfortable, the bed will slide into the “doughnut” camera. When the camera starts taking pictures, it starts to make loud noises. Some children describe these noises as knocking or hammering. Your child might benefit from seeing the camera and listening to MRI noises in the comfort of their own home prior to coming for their appointment. Be creative and help your child think of what the noises sound like (ex: “a shoe in a washing machine” or “a person building something”). Remind your child that these noises do not hurt. Earplugs will be provided to protect her hearing.

Give your child jobs to help empower him or her for the MRI. Your child's first job can be to think about something really fun like playing with her favorite character, a dream vacation, or singing songs. Their second job is to remain very still like a statue. Practice lying down and being really still before your appointment. Each scan is different, but they might need to be still as long as one or two TV shows.

If your child is unable to remain calm and still during the MRI process, doctors may suggest a sedative, or “sleepy medicine,” administered through an IV. You can tell your child she will feel a small pinch when the “straw (IV)” goes in. Encouraging your child with jobs of being still and taking deep breaths - bubbles and birthday party horns make this more fun for younger children. Bring a favorite book or stuffed animal to help distract your child during the IV placement, and assure her that you will be there to help.

It is important that you, as a parent or caregiver, stay calm and relaxed. This will help your child stay calm. Encourage your child to ask questions and be honest. Use encouraging words and help children get excited about the MRI adventure. Remember how important it is to take your child to a children's hospital for procedures like an MRI. Distraction methods and specific therapy from a child life therapist make the whole process easier for you and your child!"

Molluscum Contagiosm is a skin virus that's a lot more common than most parents would think. This pesky skin rash is harmless, but when it pops up on your child you are certain to have many questions. We talked to Dr. Sandy Arnold, infectious disease physician at Le Bonheur Children's Hospital. Here's what she had to say about the virus:

What causes the virus?
Molluscom contagiosum virus is in the family of poxviruses, which is in the same family as the smallpox virus and Variola but has very different manifestations. The virus is only found in humans and causes small, dome-shaped, flesh-colored bumps on the skin. Some lesions will have a small dimple in the center and can occur anywhere on the body, but lesions are usually localized in one specific area. It is rare to have them all over unless the individual has eczema or a compromised immune system.

Is it contagious?
Molluscum contagiosum is contagious. 

How does it spread?
It is spread through contact with lesions from a person infected with the virus. The virus can be spread through sexual contact or through objects that an infected person has touched. The bumps can spread from one part of the body to another, which is how bumps can appear on different parts of the body.

How long does it typically last?
The bumps can last for weeks – even up to a year – but will regress without treatment.

What are any home remedies and do they work?
No treatment is necessary. This infection is very common in children and is completely benign. Mechanical removal of the core of the bump with a fingernail will help the bump resolve faster, but this process can be painful. Over-the-counter salicylic and lactic acid preparations can be used for treatment. However, this is usually unnecessary as the virus will always regress without assistance.

Does it hurt or itch?
The molluscum virus is not painful. In some children, there is itching. Sometimes when the lesions start to heal, they will flare up and become red.  Following this, the lesion will fade away and will not leave a scar. This is a symptom of the body’s immune response to the virus and is normal.  Antibiotics are not required for this.

Can it be spread from child to child in a family unit?
Molluscum can spread from one child to another within a family. Adults do not tend to acquire the virus as most have been previously exposed as children.

Bottom line:
Molluscum always goes away. Generally, as with other kinds of warts, the bumps bother the parents more than they do the children.  The treatments that can be applied will likely cause more discomfort than the bumps themselves. 

Trying to decide what sunscreen is best for your child is no easy task. Le Bonheur dermatologist Robert Skinner, M.D., has some advice to make those choices easier.

“For starters parents should use what’s called a physical sunscreen that contains titanium oxide and zinc oxide. Lotions with those ingredients tend to be thicker and look white when first applied. It’s a good idea to stay away from sprays, even though they may seem more convenient for busy children. You also have to be sure you have a UVA protector, not just UVB.

UVB rays are the sun’s burning rays and the primary cause of sunburn and skin cancer. UVA rays penetrate deeper into the dermis, or basic layer of skin and can also contribute to sunburns and skin cancer.

It’s also important to check the sun protection factor level. An SPF number measures how long you can stay out without getting red, and doesn’t necessarily mean that one bottle of lotion is stronger than another. When parents look for a good level for their children, SPF 30 should be enough. Parents should reapply sun block every couple of hours, especially when children are in the water or sweating a lot. It’s also important to apply the sunscreen before going outside.

I encourage parents to be smart when considering when to apply the lotion. If you are going to the beach, an amusement park or the zoo, for example, put it on. I think anytime you’re out for a prolonged period of time, it’s best to err on the side of caution.
If you do forget, and your child does burn there’s no quick fix. Bottom line: Just don’t forget the sunscreen.”

Kate Krull is a mom to three children, including 7-year-old Lucy, a Le Bonheur patient. The Krulls have been through many ups and downs since Lucy was diagnosed with a brain tumor two years ago. Kate shares her family's struggles openly on her popular blog, 3 Kids, a Minivan and a Mortgage. She's written a touching post for us today about Lucy's story and the foundation they created in her honor: Go Lucy Go.

Becoming a mother was, by far, the most amazing thing that has ever happened to me. I call it a blessing to have had this honor three times.  I think the most profound realization came when I first held my children and immediately realized that I had never felt such feelings of love.  In an instant your whole purpose for living changes, as does your role as a woman.  You become nurturer, provider, sustainer, protector and comforter.  Hands down, becoming a mother is my greatest accomplishment. 

I read a quote once that said, “No one will ever know the strength of my love for you.  After all, you’re the only one who knows what my heart sounds like from the inside.”  Most moms never get to prove their love to their children in as dramatic fashion as I have.  When my almost 5-year-old daughter, Lucy, was diagnosed with Medulloblastoma, cancer of the brain and spine, our lives turned upside down.  For two years I held my daughter as she fought for her life.  Through her journey I found a strength that I never knew I possessed.

My husband and I vowed that even if cancer took Lucy’s health it would never take our lives.  We praise God daily for his healing blessings, and we have pledged our lives to helping others who are going through similar situations.  The time we spent at Le Bonheur Children’s Hospital opened our eyes to a world to which we had never been exposed.  Quite honestly, it is a world I wish I never knew.

When I look back on our time at Le Bonheur I am reminded of what led our family to create a non-profit organization in our daughter’s honor.  The Go Lucy Go Foundation helps support families that are coping with the diagnosis of brain cancer.  The Neuroscience Institute at Le Bonheur is one of the top neuroscience programs in the country, and families from all over the world come here for surgery and treatment.  During our two years of being in and out of the hospital for weeks at a time, we came to empathize with the families who were walking in shoes that were once ours.

Through the Go Lucy Go Foundation, we strive to meet the non-medical needs of these families by providing a food pantry, individual refrigerators for the patient rooms and grants to help parents pay for things such as food, housing, and utility payments.  One of the first things we learned after Lucy was diagnosed was that our only concern was caring for our sick daughter.  We don’t want families to be torn between being by the side of a sick or dying child and working to make sure they have food.  The Foundation also helps provide rehabilitation equipment for the Neuroscience floor and we provide hot, catered meals for the families and staff throughout the year.

Giving back to the hospital and the families it serves is our way of honoring the nurses, doctors and staff who became and remain part of our family. 

Le Bonheur allergist Dr. Christie Michael offers our readers some helpful tips when dealing with allergies. Many people suffer from seasonal allergy symptoms, and in the spring, pollen counts can be exceptionally high.  Here, Dr. Michael has addressed some commonly asked questions regarding allergies.

How do you know symptoms are from allergies?
Sometimes it is hard to know without seeing a specialist and undergoing some testing.  However, there are circumstances that increase the risk of allergic disease.  If someone gets symptoms of itching, sneezing, nose dripping/draining the same time every year or, for example, every time they are around a cat, allergies may be implicated.  Usually the common cold will last about a week if you treat it and seven days if you don't, so another sign is congestion that lasts longer than a week.  A family history of allergies, a personal history of eczema, or a food allergy also increases the risk. Eye itching and swelling are more common in allergies as well.

How can you get relief?
If you know the triggers for your symptoms, of course, avoiding them when possible and practical is ideal.  If you have been outside, showering and changing as soon as you come in will help. Also, rinsing your nose or sinuses with a saltwater rinse (available at drug stores without prescription) can help. As far as medication, many people with allergies can get relief with over-the-counter antihistamines. These medicines are safe, effective and the dosage is by age so they are easy for parents to use. Diphenhydramine (Benadryl) is an older medication that can cause some sedation but is very effective.  The newer antihistamines are also very good and less likely to make you sleepy.  These include loratadine (Claritin) and cetirizine (Zyrtec). 

If there is a lot of congestion, there are nose sprays that your physician can prescribe.  Over-the-counter nose sprays should be used for only a few days at a time as they can be addicting and cause worse “rebound” congestion.  Ask your doctor which ones are safe to use and for how long.  For eye symptoms, your doctor can prescribe eye drops to be used once or twice daily.  If there are only a few days out of the year that you suffer from eye symptoms, the over-the-counter allergy eye drops are fine (usually have a capital A at the end of the name).  Artificial tears can provide relief from irritation, especially if refrigerated, and are a great alternative to rubbing!  Again, if you are not sure, ask your doctor or pharmacist.

When should you see a specialist?
If the usual measures above do not adequately relieve your symptoms, then you should see an allergy/immunology specialist for further evaluation.  Also, if you or your child suffers from asthma you should consider a specialist evaluation as allergies can trigger asthma attacks and lead to more frequent asthma symptoms, both interfering with daily life and putting you at risk for a severe attack requiring hospitalization. Your allergy doctor may recommend a course of "allergy shots" to desensitize you to the things that trigger your allergy symptoms.

What are the signs and symptoms of asthma?
Family history of asthma and personal history of allergies again increase the risk of asthma.  The cough and wheeze are “cousins,” so any bad spells, especially with exertion or during the night, may be a sign of asthma. Chest discomfort or atypical shortness of breath (occurring with little or no exertion or causing a child to seek rest long before peers) should always be discussed with your doctor.

Learning about a new diagnosis can be a scary thing for parents. For one South Carolina family, the Prossers, Le Bonheur has offered comfort. Their 14-month-old daughter, Carly, has been treated by Dr. James Wheless and the Neuroscience Institute's care team. Amy, Carly's mom, shared a bit of her Le Bonheur story below.

"Jeremiah 29:11 says 'For I know the plans I have for you, plans to prosper you and not to harm you.  Plans to give you a hope and a future.' 

In January of 2012, our lives were forever changed with the birth of our second daughter, Carly. In June of 2012 she was diagnosed with cortical blindness. Two months after her initial diagnosis, she began having infantile spasms, a type of seizure. 

This past January we found Le Bonheur and Dr. James Wheless, co-director of Le Bonheur’s Neuroscience Institute and professor and chief of Pediatric Neurology at the University of Tennessee Health Science Center. We are so thankful and grateful for Le Bonheur and its amazing staff as they walk this journey with us and help to prepare us for God's plan for Carly and our family's future.  Carly has been admitted to the Epilepsy Monitoring Unit (EMU) at Le Bonheur three times now; here, we have made countless friends and met some of the most courageous families walking a similar journey of their own. The kindness of strangers has been truly amazing. 

As a nurse myself, I have never met such a compassionate and caring medical team. We have had many tests and procedures during our hospital stays and have encountered exceptional people in every department. We live in South Carolina and will continue to travel to Le Bonheur for Carly's care. We are so thankful for our Carly and the impact she is already having on our family and so many others. This is an incredibly special place that feels more like home every time we return. Le Bonheur truly loves their children.  Thank you for loving Carly and giving us hope and a future."

New parents can be confused about when and how to begin feeding infants solid food. We talked to local pediatrician Dr. Katie Alvord about what advice she'd give parents:

“I recommend that parents start introducing solid foods after 4 months of age. At this age, your baby has likely reached certain developmental milestones that allow for safe feeding. 
Those milestones include:

• Sitting in an upright position with good head control 
• Opening his or her mouth to take food

The first solid food a child should eat is baby cereal. It should always be prepared in a bowl and given with a spoon. Cereal given through a bottle only increases calories and provides no developmental exercise for your baby.

Babies should begin learning how to move food from the tip of the tongue to the back of the throat to swallow. It seems easy, but babies have only been taking liquid through a bottle or breast up to this point. The consistency of the cereal should be almost as thin as liquid. Parents may thicken it as the baby’s comfort level acclimates to the texture.
Breast milk and/or formula should still provide the majority of your baby’s nutrition until 12 months.  For this reason, make sure you continue to offer 32 oz. of milk a day.

One more important bit of advice: Have fun with it! Watching your baby begin to eat is one of her greatest milestones. Messy, but wonderful!”

In-toeing, sometimes called “pigeon toe”, is a condition that causes the toes to turn inward when walking or standing. Is it something children can outgrow? Derek Kelly, MD, an orthopedic surgeon with Le Bonheur and Campbell Clinic, answers some common questions about this condition.

"The three main causes are Excessive Femoral Anteversion, Internal Tibial Torsion and Metatarsus Adductus. Excessive Femoral Anteversion is a twisting of the thigh bone that is commonly present in most children when they are born and tends to correct slowly as a normal part of growth.  Some children have more twisting than others, but in the majority of cases, it will usually resolve without any treatment. 

Internal Tibial Torsion is a very similar type of twisting, but occurs in the shin bone.  It will also typically resolve with growth.  Metatarsus Adductus is a turning in of the forefoot, which includes the toes and the front half of the foot. This is likely related to limited room in the womb. 

These conditions are likely inherited. Typically one of the parents and one or more of the grandparents might have been evaluated for this as a child.

Treatment is rarely necessary. The majority of the problems will resolve as a normal part of growth.  In most cases, in-toeing is completely normal. If you are concerned, then your pediatrician, therapist or orthopedic surgeon should rule out other rare causes of in-toeing like birth defects and neurologic or muscular diseases. Occasionally casting, bracing or physical therapy may be helpful for in-toeing unrelated to normal growth. Surgery is very rarely required."

Meet Tim Flack, incredible father, husband, community advocate and Le Bonheur Associate. Tim took his own personal journey to heart and decided to leave a career as a prosecuting attorney to come to Le Bonheur to direct our Family-Centered Care program. Tim’s job here is to listen to the needs of our patients and incorporate them into the everyday practices at Le Bonheur. Tim’s daughter, Madeline, is a patient, and he truly understands the critical importance of everyday family-centered care. Read Tim’s personal influences below. We are so glad to have Tim advocating for our families; thank you, Tim Flack!

“In March of 2006, my then 10-month-old daughter, Madeline, was diagnosed with four congenital heart defects. She underwent open heart surgery at Le Bonheur's Heart Institute and still today continues to be a cardiac patient and frequent flyer. The fact that Madeline is with us today and enjoying a full and happy life is due to the people of Le Bonheur. My wife, Bridgette, and I feel we owe a debt of gratitude that we can never repay. The opportunity to come and work here was a dream come true for our family.

What I love most about my job here is the opportunity to work with such a great team of people who are so dedicated to healing and supporting children and families. It is an honor and a privilege to be able to come alongside so many talented people and work together with them to continue to provide top quality, patient- and family-centered care.”

When is coughing or wheezing during exercise more than just signs of exertion? We asked Dennis Stokes, MD, chief of Pediatric Pulmonology at Le Bonheur Children’s, to help parents understand if their young athlete could have exercise-induced asthma. The Pulmonology department at Le Bonheur was recognized on U.S. News & World Report’s Best Children’s Hospitals list. Here’s what Dr. Stokes had to say:

What are the symptoms of exercise-induced asthma?
Signs of possible exercise-induced asthma include inability to exercise or participate in sports in a child with known asthma -- or increased shortness of breath, coughing, chest pain or wheezing with exercise in any child. Outdoor exercise in cold, dry air is particularly likely to exacerbate exercise-induced asthma.   Any exercise can be a trigger for exercise-induced asthma, but the more intense the exercise (i.e., with sports like basketball, soccer or hockey), the more likely it is to trigger symptoms.  For children with asthma, symptoms during exercise can indicate inadequate control of their asthma. 

How should it be treated?
Most exercise-induced symptoms can be relieved by using a rescue inhaler (albuterol) 20 minutes before exercise, and some other medications such as montelukast (like Singulair) can also be helpful.  If albuterol doesn’t relieve exercise symptoms, then your child should be tested for other causes of these symptoms. Poor conditioning, vocal cord dysfunction and some cardiopulmonary diseases can present like asthma. 

Exercise testing can be very helpful for determining whether your child has exercise-induced asthma. These tests include two types: 
• a simple exercise provocation test where lung function is measured pre and post exercise;
• full metabolic exercise study, which includes graded exercise along with monitoring of heart and lung function

Today is World Autism Awareness Day. Even if someone in your family hasn’t been affected by autism, you probably know someone who has. According to Autism Speaks, an average of one in 88 children has an autism spectrum disorder (ASD).

Le Bonheur neurologist Kathryn A. McVicar, MD, who specializes in autism spectrum disorders, shares some important information about the disability.

What is autism?
Autism is defined by behaviors that occur together.  These are:

• problems with understanding the meaning of language and communication and the inability to convey meaning through language and communication
• problems with socialization or not understanding how people interact and work together
• a restricted behavioral repertoire, or a need for sameness

What are the initial signs of autism?

• Late talking
• NOT reacting to or recognizing his/her own name
• Poor eye contact
• NOT sharing experiences by pointing, gestures or verbalizing
• Prefers to be alone
• Appears to be in his/her own world much of the time
• Oversensitive to sounds, textures, smells, or certain foods
• Repetitive and obsessive behaviors

What treatment is available?
There is currently no treatment for autism, but early intervention is strongly recommended for children younger than 3 on the autism spectrum. Speech and language therapy, as well as therapy services that help autistic children learn to interact with others, are proven to help their development. Le Bonheur Early Intervention and Development provides services for kids in our community younger than 3 years with an ASD.

Symptoms of other disorders occurring with ASD, such as ADHD or sleep disorders, can be treated with medication and/or therapy.

What causes autism?
The exact cause of autism is not known in most cases, but scientists say there is a genetic risk factor. If a child’s sibling or parent has an ASD, he or she is at greater risk to develop an ASD.

Sometimes ASD occurs in the setting of a specific identifiable disease such as neurofibromatosis or tuberous sclerosis.

No link has been found between vaccinations and autism spectrum disorders. The American Academy of Pediatrics and the Child Neurology Society both recommend vaccination for all children to prevent childhood diseases that have caused severe harm to children in the past. 

What should a parent do if he or she suspects his/her child has autism?
If your infant or toddler shows any of the above signs of autism, consult his or her pediatrician. A pediatrician can screen your child for the disorder and may refer you to a specialist. The earlier a diagnosis of autism is determined, the better the child does in the long run.  Education and intensive behavior therapy are the only proven interventions that work for all children on the autism spectrum.  A specialist or pediatrician can connect you to resources to help your child.

You can also contact Tennessee Early Intervention Services for further evaluation and therapy.

Only at a children’s hospital can patients and their families perform mini MRIs on their own adorable teddy bears. Last Friday at Le Bonheur Children’s Hospital, patients participated in the “Teddy Bear Clinic” where they were able to perform procedures like X-rays and IVs. The clinic lets the children see first-hand how the procedures are performed on their very own teddy bear. Local reporter Sarah Bleu from Fox 13 reported the story. Check it out; we promise it will make you feel warm and fuzzy all over!

Tennessee First Lady Crissy Haslam surprised patients with a visit to Le Bonheur Children's Hospital last week. She is an advocate for early intervention and childhood literacy and read Perre Magness’s book, We Live in Memphis, to children during her trip.

Students and faculty from St. Mary’s Episcopal School, Mrs. Haslam’s alma mater, attended the event and participated in the reading. Shelby County Mayor Mark Luttrell spoke and recognized the efforts of the Early Success Coalition for collaboration around Memphis to help give children a healthy start in life. 

It was another great day to be a Tennessean – in the company of our First Lady, patients and staff at Le Bonheur Children’s Hospital and many others who are working together to do what's right for kids.

Some of Mrs. Haslam's main messages for families include:

• By the time your baby turns 3 years old, his brain has already reached 80 percent of its adult size.
• You are your child’s first teacher.  As a parent, you can help your baby reach his full potential.
• Your touch can help build your baby's brain? Hug your child; caress those tiny toes; cuddle him in your arms. These simple things will help him learn and grow.
• Reading to your baby can help promote brain development, too. Start when she’s a newborn.  Tell her a story and show her the words and the pictures.