Impetigo

I have been getting a lot of calls lately from concerned parents who have gotten a notice from school or daycare that their child has been exposed to impetigo.

Our world is full of bacteria. There are beneficial ones and dangerous ones.

We are constantly surrounded by potentially harmful bacteria that seem to have the "if you don't bother me, I won't bother you attitude". Many folks, without being aware of it, are carriers and routinely  have bacteria such as staph on their skin.

Our skin is our all important protective barrier. Bacteria that is not causing any trouble as long as it remains on the outside of the body can wreak havoc if it makes it's way in. When there is a break in the skin from a cut, bite, or an itchy rash that has been scratched, the bacteria can take advantage of that, enter the body and cause an infection.

Impetigo is one of the most common skin infections out there.

It is usually caused by either Staph or Strep. By far, most of the time Staph is the culprit

There are two types of impetigo.

Bullous impetigo is less common and usually shows up in much younger children. This is characterized by large pus filled blisters.

More common is the non-bullous impetigo, this will have crusty, rashy areas that may have a honey colored glaze. Most of the time you will see these lesions around the mouth and the nose.

This also often affects the diaper area, but  can show up anywhere, more often on exposed parts of the body.

These spots and rashy areas can spread. They don't seem terribly painful and most of the time your child might seem quite well. The spots simply may flare up on and off  but usually don't  clear up completely without treatment.  

(super red/open rashy areas around the butt might be strep. We can do a test for that in the office) 

Young children and school age children are the most common victims of Impetigo, likely because they tend to come into more 'close contact' situations with others.

It is easily spread from direct touching with an infected person,or from coming into contact with contaminated surfaces like toys.

The incubation period is 1-3 days.

If you are dealing with  a very small area, the standard treatment  is an antibiotic ointment. With a really mild infection over-the- counter Neosporin may take care of it. If you don't notice an obvious improvement within 48 hours you may need to be seen or talk to your doctor about getting a prescription ointment called Mupirocin (Bactroban is the trade name).

Some cases are severe enough to warrant a course of oral antibiotics. In our office we will almost always want an office visit to help make that determination.

If a family member has been diagnosed, wash any sheets, towels, toys etc

To prevent getting this in the first place, good hand washing is key.

Do your best to keep skin safe and intact. Dry, itchy skin is more at risk because of the tendency to scratch. Eczema seems to easily  get infected areas. Keeping the skin well moisturized can help. Calendula cream is thought by some to have a natural antibacterial property.

Keep nails short to avoid damaging scratching.

To prevent infection, any mild cut or open lesion should be kept covered  with an antibiotic ointment applied 2 or 3 times per day.  

If your child has a case of impetigo or has been exposed you may also want to put a thin film of Neosporin or Mupirocin  under the fingernails and inside the each nostril twice a day to prevent spreading. Dr Schwanke is a big advocate of getting the ointment inside of the nose since that is often the source of the bacteria.

Another thing to consider is a bleach bath. "What?" you say.

I know, the first time I learned about this I was fairly dubious, but it is currently a strong recommendation from many dermatologists.

Adding ¼ cup of basic bleach to a standard tub can be useful for preventing and treating a multitude of skin afflictions. This will kill any staph or bacteria that is hanging out on the skin. It turns out that it is usually not at all irritating and has very few adverse effects.

I just learned another fact that knocked my socks off. A recent study claims that at least 30% of our tubes of various ointments are contaminated with bacteria. It doesn't take much thought to figure out how that would happen. We touch the tube tip with our unwashed fingers, or we touch the tube to the surface of our skin.

Do me a favor, from now on, try to keep any new tube sterile. Squeeze the dose of ointment or cream onto an applicator (you can use a spoon) and avoid having any direct contact with the tip or rim.

Okay, to sum it up.

If you are one of the families who got the Impetigo warning....

Hopefully your school setting has done it's job and has thoroughly cleaned toys, surfaces etc.

Aside from that, checking your child to make sure they have no spots anywhere is the only action plan that I would advise.

If they have any questionable spots, treat as discussed.

As I mentioned in my recent post about contagiousness, A notice about impetigo exposure would not be a reason to keep them home from school.

Chances are, unless you have been out of day care for an extended period,  they have already been exposed.

Pet Safety

Please see updated post May 2016

I personally think that most families are enriched by having a pet.

Of course, as an advice nurse I have a bit of an unusual take on things. I do get plenty of animal related calls.

A little knowledge and planning can help keep the relationship between your pet and your child happy and safe. 

For those of you who already have pets living with you, I understand that animals are essential and much loved members of the family. In some cases they may actually feel like your first child,  but  here are a few things to consider:

Cats:

Many cats are quite happy to welcome a baby to the family, but cats are cats. Once your child has the ability to chase after them, the cat will usually establish dominance once or twice with a good swipe.  Kids (and new puppies) learn pretty quickly what the rules are.

Do watch out for cat scratches, they can get infected fairly easily. It is essential to clean them well and apply an antibiotic ointment. (Don't use peroxide, current thinking says to avoid it because it causes  tissue irritation). If there is any increasing redness or red streaking appearing around the scratch site, that might be a sign that it is infected and it should  be evaluated.

If your crawling child starts getting little spots, consider that they might be flea bites. Fleas are rampant here in San Francisco year round. When not on your pet, fleas tend to hang out in the carpets and while they might not bother you, your child is spending more time on the rug and presents a tasty treat.

Please do your best to keep your kitties out of your baby's crib or bed. I know I sound like an old grandmother, but it is  a safety hazard for a cat to snuggle around an infant's face.

Meow mix has never hurt anyone, but you want to make sure that the cat food is not left out where your toddler can get into it.

Now, getting a little more disgusting, make sure the litter box is somewhere where the child has no access. You don't want to be the parent who calls me horrified that their baby just had a snack of cat poop.

Dogs:

Make sure you closely supervise any interactions with your dog and your new baby to make sure the dog is not exhibiting any behaviors that you need to worry about.

If the dog is at all growly, as heart wrenching  as it may be, they might need to be placed in a home with no kids.

Most dogs are perfectly wonderful with the children but even with the most loving dogs please make sure that your baby or toddler is not allowed near them at meal time. Let your doggy have a baby free zone where they can eat in peace.

By far most of the bites that I get called about are food related.

Just recently we had a toddler get bitten by the family dog. One of those "treat balls" was unearthed under the sofa where it had been hiding for months. The dog got very territorial when the toddler tried to get it and the baby took the brunt of it.

Bites by a family dog are the rare exception. By far most of the animal bites that I get called about happen outside of the home. 

If you are visiting a friend or relatives house and they have a pet. Ask them explicitly if the animal has any history at all of aggressive behavior with children. Some folks have a blind spot where their beloved pets are concerned and lose their common sense. If there is any doubt please ask that the pet be kept away from your child.

If you are walking down the street, teach your child that before you pet any strange animal you ask the owner for permission.  Some animals tied up outside a store may be stressed and don't feel comfortable being approached.

Once you have the all clear to say hello, demonstrate the safest and best way to meet an new animal.

Show  them how to hold out their hand first and let the animal give them a sniff.

For younger kids, consider teaching them the one finger petting technique have them make a fist except for the pointer finger. This way they can pet the animal with that one finger without grabbing hunks of fur.

My youngest Alana kept me on my toes.From the minute she could crawl, she was scampering across the park to say hello to anything with fur.

If you don't have a pet and are considering getting one:

I am a total animal lover and I think that having a pet  is a wonderful thing.

In our case our family was adopted by a stray Siamese cat when Lauren was still a baby. He lived a very long life and I am sure never regretted choosing us as his family.

We also wanted a dog.

My mother-in-law had plenty of strong opinions. Amongst them were some pearls of wisdom that resonated with me..

Her theory was:

*All children need a dog, teenagers especially so. There is nothing quite like the unconditional love of a dog to get you through tough times.

*The last thing an adolescent needs is to lose their dog during those tumultuous years.

*Barring an unforeseen tragedy, the lifespan of a dog is roughly predictable, so plan accordingly.

When she first mentioned this to me I was actually a little horrified. It felt so callous and calculating, but when I thought about it a little further and it made perfect sense.

We ended up getting our beautiful golden Java when my girls were 9 and 12. We were blessed to have her with us for 12 wonderful years. Our family was much richer for it.

Do know ahead of time that as much as you bargain with your child and make agreements about how the dog responsibility will be shared....just give up right from the start. The dog is yours. You will be the one remembering to feed them, doing all the walks in the rain and the poop scooping. Trust me.

Luckily the value of getting a family pet goes way beyond teaching your child responsibility.