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.”

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.

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."

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

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!

Cuts and scrapes go hand in hand with kids. Sometimes, they require a trip to the emergency department for further evaluation. There are several options if the cut requires medical intervention – stitches, glue or staples. We talked to Dr. Jonathon Jacobs, an emergency medicine physician at Le Bonheur Children’s Hospital, about these options and best treatments. Here’s what he had to say:

Glue is best used for cuts or wounds that meet the following criteria:

• small (less than 4 cm)
• clean (not contaminated with dirt/debris or have a risk for infection)
• linear/straight (no jagged edges, multiple edges or complex cuts)
• low tension wounds (a wound over a joint or a cut on the forehead that goes up and down is under high tension.)

Glue cannot be used near the eyes or mouth and is also not good on the hands due to hand-washing wearing it away.     

Neither glue nor stitches is necessarily a better method than the other; stitches and glue have the same cosmetic result as long as you follow the criteria above.

When applying stitches or glue, some doctors will use numbing to wash out the wound. The application is usually not painful if numbing is used, and a local anesthesia shot in the wound is very effective. While it is briefly painful, it works in just a few minutes. Sometimes a combination of numbing solution and shot works best; the solution will make the shot much less painful. When a child receives stitches, some form of numbing is necessary.

We still use staples in select situations. The most common being a laceration or cut of the scalp where, cosmetically, it's not as much of an issue.  It's fast, easy and very effective. 

Glue goes away by itself.  Some stitches are absorbable and also go away by themselves. Those are usually used for the lips, mouth and in young children. With younger children, we use absorbable stitches to avoid sedation for suture removal. 

I think it's always worth asking if glue is appropriate with the understanding that it's used in very specific and limited situations. Most often, when some form of closure is needed, stitches are used.  As always, good wound care and follow up is important to ensure the wound heals appropriately. 

Meet the Fosters. Their son, 16-year-old son Andrew Foster suffered from a heart anomaly that, if undetected, would have been fatal. Andrew was an active athlete at Memphis' Briarcrest High School who began suffering from bouts of dizziness, nausea and weakness during practices. His parents took him to see Dr. Rush Waller, a cardiologist at Le Bonheur Children’s Hospital. Andrew was then diagnosed with anomalous right coronary, the leading cause of sudden death in athletes. View the Fosters story and meet Dr. Waller, who is a great example of why children’s hospitals and their experts are important for kids. 

Like many parents, you have probably noticed new and different types of milk at your grocery store. Over the last few years, several reasonably priced options have become available.  These include soy milk, almond milk, coconut milk and rice milk.  So which is best for my family?  Katelyn Wolfe, MS, RD, CSP, LDN and Clinical Dietitian at Le Bonheur Children’s Hospital has you covered. Keep reading for a breakdown of the nutrients in the different milks and her expertise in which is best for who.

"With so many options, which one should you pick? The AAP recommends not doing any cow’s milk until a child reaches 12 months, and at that time, whole milk is recommended. For children who are two or older and considered overweight or obese, the best option is skim or 1% milk. This is not only because of the fat and calorie content, but also because of the amount of protein when compared to the other milk varieties.

Basically, unless your child has an allergy or your family eats a vegan diet (no meat, dairy, seafood, eggs) the best and most economical choice is cow's milk. 

For kids with allergies, the parent must fine tune their selection. If your child has an allergy to both cow’s milk and soy, he or she may be more likely to have a nut allergy, and therefore almond and coconut milk would not be an option.  Many kids with multiple allergies drink rice milk as their option and have to get protein from other foods in the diet. If you suspect that your child has a food allergy or have concerns with his or her weight, speak with your pediatrician as these concerns may need extra medical attention.

As you can see from the break down below, all of the choices have similar calcium and vitamin D amounts.  The difference is in the calories, fat and protein."

                                          Calories    Fat        Protein      Calcium**       Vitamin D**

Whole milk                          150 kcal     8 g         8 g            30%                25%
2% milk                               120 kcal    5 g         8 g            30%                25%
1% milk                               100 kcal    2 g         8 g            30%                25%
Skim / Non-fat milk                80 kcal    0 g         8 g            30%                25%
Soy (original)                        90 kcal    3.5 g       6 g            45%                30%
Soy Light (original)                 60 kcal   1.5 g       6 g            45%                 30%
Almond milk (original)             60 kcal   2.5 g       1 g            45%                 25%
Coconut milk                         80 kcal     5 g         1 g            45%                 25%
Rice milk                              120 kcal   2.5 g       1 g            30%                 25%

* All information based on 8oz serving.  Note that varieties that are flavored such as vanilla or chocolate will have more calories from sugars used to flavor the beverages.
** Based on needs for a typical adult.  A child may need less or more based on age.

February is American Heart Month. Did you know that the Heart Institute at Le Bonheur Children’s Hospital is ranked nationally by U.S. News and World Report as a top cardiology and heart surgery program? Our cardiologists and cardiothoracic surgeons provide excellent care for patients with congenital heart defects from before birth to adulthood.

Le Bonheur’s Heart Institute houses state-of-the-art catheterization labs that showcase some of the greatest technology in the field of pediatric cardiology. Three-dimensional reconstruction capabilities and expertise in cardiac MRI allow for quicker diagnoses, better planning for surgeries and minimal exposure to radiation. Our surgeons and cardiologists carefully work with the families to plan for optimal outcomes that will give your child the best quality of life possible. Our Adult Congenital Heart Disease program provides long term care plans, cardiology check-ups and care tailored perfectly for adults living with a pediatric heart defect.

The Heart Institution team provides cardiology coverage at St. Jude Children’s Research Hospital and conducts joint research to better improve the lives of children with heart defects.

Le Bonheur's Heart Institute evaluates and treats all forms of congenital and acquired heart disease such as:

• Anomolous coronary artery (ACA)
• Aortic stenosis
• Atrial septal defects (ASD)
• Atrioventricular canal
• Bacterial endocarditis
• Coarctation of the aorta
• Ebstein’s anomaly
• Heart murmurs
• Heart tumors
• Hypoplastic left heart syndrome (HLHS)

If you are researching heart programs, cardiologists or cardiothoracic surgeons for your child, learn more about our Heart Institute. To make an appointment or see one of our physicians, visit www.lebonheur.org/cardiac or call the Le Bonheur Referral and Resource Center at 901-287-7337. By visiting our website listed above, you can learn more about our 16 cardiologists and 4 cardiothoracic surgeons through their individual bios photos and credentials.

Many children participate in a sport of some sort. A reader asked about using Kinesio Tape (K-Tape) when participating in sports activities. Her main questions were: is it safe, what does it do and can the kids put it on themselves. We talked to Jennifer Scholler, a physical therapist at Le Bonheur. Here’s what she had to say.

“Kinesio Taping® is the use of an elastic tape to assist muscle and other tissue function. It was first used in Japan in rehabilitation settings and in the late 1980s was first used on athletes. It was officially introduced in the United States in 1995 and today is primarily used on the non-athletic population.

There are four major physiological effects of Kinesio Taping®
• To relieve pain or abnormal feeling on the skin and muscle;
• To support the muscle in movement;
• To remove the build-up of lymphatic fluid;
• Correct joint misalignment by helping muscles work better;

K-tape is used in the pediatric world primarily for helping to improve joint and muscle function. Treatments are tailored based on a child’s unique strengths, needs and goals.It can be used to improve muscle contraction of a weakened muscle, inhibit contraction of an overused muscle or a muscle with increased tone, and assist with retraining a muscle. The tape is applied differently depending on the outcome desired.

Meet Dr. Karen Lakin, director of Le Bonheur’s Child Assessment Program (CAP), which evaluates children entering our hospital who are possible victims of child abuse and neglect. Patients are referred to CAP by physicians and social workers in the hospital who are concerned that a child’s current injuries may be the result of maltreatment. When children are referred, the team performs medical and psychosocial assessments of those children and their families. Dr. Lakin is a critical component to this program and a well-known expert in her field. While we understand this is a very tough subject, we also want to encourage our readers to educate themselves on this important issue. Dr. Lakin talks about recognizing and preventing child abuse in today’s post. Here’s what she had to say.

"All too frequently we read a headline in the paper or hear a report on the evening news detailing an account of a horrific case of child abuse, sometimes ending with the death of a child. We find ourselves asking each other, “Did you hear about that young child who was murdered?”  “How could that monster rape those children?”  “Didn’t anyone notice the poor child was being abused?” 

Have you ever found yourself in a situation where you were concerned that a child was being abused?  You must first recognize the signs of abuse in order to help a child. Child abuse comes in many forms: physical abuse, sexual abuse, emotional abuse and neglect.  Some types of abuse leave obvious signs, while other signs are more subtle.  Often, the various types of abuse overlap.  A physically abused child may also be neglected and not have medical needs addressed by the caregiver. A sexually abused child may also be emotionally abused by the predator.

Signs of physical child abuse include injuries that are inconsistent with the explanation. A child may suffer from recurring injuries or repeated trips to the emergency room. Injuries blamed on behaviors that are inconsistent for the child’s age are suspicious for abuse. A caregiver may give different stories to explain an injury. 

Signs of sexual abuse may be more difficult to notice. These include sophisticated sexual knowledge or behavior in a young child. A sudden change in sleep patterns, nightmares, bedwetting or physical complaints like headaches and stomach aches are also warning signs. Physical symptoms may include frequent urinary tract infections or contraction of sexually transmitted diseases. Often, a child may disclose a sexual abuse incident to an adult. Sometimes this may be the only sign, therefore all accounts should be taken very seriously.

Emotionally abused children are often belittled or berated. They may be ignored by the caregiver or treated poorly in comparison to siblings. Neglected children may be unkempt, malnourished or frequently unsupervised. In this particular situation of abuse, a child’s medical, educational and physical needs may not be provided by caregivers.

Child abuse is a difficult subject for everyone and many people are confused about reporting it.  Fear creates barriers to reporting.  We may be reluctant to become involved if we don’t know the child. We may fear breaking up a model family, that no one will believe us or get in trouble for reporting abuse if it is unfounded. 

Reporting child abuse may save a child’s life and is a person’s moral responsibility. In Tennessee, as in most states, reporting abuse is also a legal responsibility.  All persons, including doctors, mental health professionals, child care providers, schools, dentists, family members and friends must report suspected cases of child abuse or neglect. Failure to report child abuse or neglect is a violation of the law in Tennessee."

To report Child Abuse or Neglect you may contact your local law enforcement agency and in the following states contact the child abuse hotlines:

Tennessee 1- 877-237-0004   or https://reportabuse.state.tn.us/
Arkansas 1-800-482-5964
Mississippi 1-800-222-8000 or https://www.msabusehotline.mdhs.ms.gov/

In the event of an immediate life threatening emergency, call 911.