fodder for tetanus…don’t get this stuck under your foot

Look at this rusty old anchor atop an old fort. Rust plus dirt equals a perfect breeding ground for tetanus. As my kids scampered between different anchors last week, I quickly calculated in my mind whether their preventative tetanus shots were up to date.

“Getting the tetanus shot” is part of the American societal childhood rite of passage, but most people don’t know much about why their kids are vaccinated. Everyone knows they want to avoid IT, but what is IT? Because it is somewhat rare in the United States, I still remember asking one dad about his child’s family history. I was startled when he erupted onto peals of laughter after he told me the child’s grandfather had died of tetanus. “Why are you laughing?” I said in disbelief.

“You’re right, it’s not funny… It’s just the look on your face is funny,” he said. “Everyone has the same shocked expression when I tell them that he died from tetanus.”

Also known as Lock Jaw, tetanus is an organism which thrives in places with little oxygen. Thus, it tends to live on rusty nails (and anchors!) and deep in dirt. Tetanus secretes a poison which causes muscles to spasm painfully and severely and also causes seizures. Exposed to tetanus, your jaw muscles clench into a sardonic smile which prevents eating – hence the name Lock Jaw. Eventually, the tetanus poison infiltrates the chest muscles that help you breathe, and if you are like nearly 40 percent of cases, you will stop breathing and eventually die.

We have no antidote for the poison of tetanus- but we do have a preventative immunization which causes our bodies to preemptively prepare antibodies as self-defense. At the time of a high risk injury, if needed, doctors will boost your child’s tetanus immunization. If your child is under- immunized, the doctor will also inject your child with tetanus antibodies (tetanus immunoglobulin) to further ensure that your child will not contract this disease.

Because tetanus thrives away from oxygen, it easily multiples in deep wounds contaminated by the germ. The germ surrounds us in soil and also lives in intestines of humans and animals. Since tetanus lives in dirt, the following are considered “high risk” injuries:

   -Bites from animals which dig and “eat” dirt such as dogs.

    -Deep puncture wounds from dirty, rusty nails.

    -Wounds with embedded rocks and gravel.

Be wary of tetanus in wounds possibly contaminated with stool, dirt ,or saliva. In developing countries, there are continued cases of infantile tetanus because poultices of mud are used to take care of the umbilical cord stump of newborns.

For kids, the recommended ages for tetanus shots are at 2 months old, 4 months old, 6 months old, 15-18 months old, 4-6 years old, 11-12 years old, and then every ten years through adulthood. Note, if a high risk wound is sustained, the last shot should be within five years. Thus, a kid around 9 years old may be up-to-date for shots, but because he received a tetanus vaccine at four-years-old (on time) he will still need an immunization at the time of a risky injury. Watch out also if you have a teen. His pediatrician will immunize him at 11-12 years of age, but after 16-17 years old he will need a booster if he sustains a dirty wound.

Nowadays, the tetanus immunization is in the same solution as an immunization against diptheria (a disease that causes a choking-inducing coating at the back of your throat), and usually in the same solution as pertussis (whooping cough). If your doctor gave your child an immunization recently against pertussis, she also received a tetanus immunization.

Kids are expected to get dirty. Enjoy the dirt—just not the tetanus.

Naline Lai, MD with Julie Kardos, MD
©2012 Two Peds in a Pod®

Two Peds in a Pod® turns three years old! In honor of our third birthday, we bring you our top ten parental experiences through the years list:

1. “Helping” your child manage his ice-cream cone (especially when he orders the soft chocolate kind with the chocolate sprinkles)
2. Coaching a sport you have not played in twenty years.
3. Playing hours of Mario Cart or Just Dance on the Wii (and losing every time)
4. Building snowmen
5. Coloring with brand new crayons (and the aroma of opening that new box of Crayolas!)
6. If you are a mom, discovering your teen daughter is the same shoe size and you can borrow her hip shoes
7. Experiencing your child’s first bike ride without training wheels
8. Getting to be the Tooth Fairy (shhh… don’t tell!)
9. Re-reading your favorite kid books (Dr. Seuss really was a genius)
10. Realizing your child honestly believes that you have a really good singing voice

We hope to celebrate many more birthdays with you. Please continue to send us your ideas at twopedsinapod@gmail.com, comment on our posts and tell your friends about us. 

Happy,

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

Vacation! As I watched my kids scamper across the beach today, I remembered a conversation I had with a family recently. “My kid sometimes coughs up sand,” the mom said to me. “Little hard specks sometimes come out of her mouth. ”

“Hmmm, bring me a speck of the ‘sand’ the next time he spits one out,” I said.

A few days later, rattling inside a small plastic container on my desk, I found a tawny-hued speck which resembled a chip of rock. The mom had kept her promise and now I was the owner of a tonsillolith. Pictured here next to a paperclip, this and other tonsilloliths are harmless hardened pieces of debris which lodge in crevices (crypts) of tonsils. No one is exactly sure why tonsilloliths form, but they do seem to run in families. A combination of the right type of saliva, food, and deep tonsillar crevices produce these white or tan specks which occasionally become the size of a small pebble. In fact, they are also known as tonsil stones. Most people consider tonsilloliths a nuisance, but sometimes they are associated with bad breath. Warm salt water gargles after meals (one teaspoon of salt per 8 ounces of warm water) is usually enough to dislodge the tonsilloliths and prevent new ones from sticking. People have been known to overcome gag reflexes and flick them out with their nails. Addressing any tonsillar irritation such as Strep throat infections (see our previous posts: part one and two) or post-nasal drip from allergies may also be helpful. For those having continual tonsillolith-induced bad breath, removal of the tonsils is the definitive answer.

Some people dream of getting away to Sannibel Island’s shell covered beaches, others to Bermuda’s wispy pink speckled beaches and still others to the jagged rock-strewn beaches of Maine. Do otolaryngologists (ENTs) dream of tonsillolith-covered shores?

Naline Lai, MD with Julie Kardos, MD
©2012 Two Peds in a Pod®

Lucky kid!  My daughter’s first rock concert, and not only did her girlfriend score tickets to the hot teen band One Direction, but the girls sat in 9th row seats. Despite fears of appearing dorky, my kid took along a box of earplugs. A half-hour into the concert, the mom accompanying the girls texted me. “Earplugs a necessity,” she wrote.

No, it’s not a myth your parents told you as a teen to keep you miserable at home on a Saturday night. Loud music really can cause high frequency hearing loss. 

Sound is described by decibels (loudness) and by frequency (pitch). Examples of high frequency noises are the sound of a nail scratching a chalk board or a person whispering. A very high frequency noise is the sound of a dog whistle. By thirty years old, almost everyone experiences some hearing loss at frequencies above 15 hertz – if you are this age, this is why everyone now seems to mumble at parties. A few years ago, teens capitalized on this natural hearing loss phenomenon with “mosquito” ring tones– high frequency cell phone rings heard only by younger ears but not by prying adult ears. For kicks, check out your ability to hear high frequencies at this non-scientific site.

Exposure to loud sounds at high decibels hastens the natural progression of high frequency hearing loss. Damage to the hearing nerve (cochlear nerve) in an ear can occur from a one time exposure or from repetitive exposure over time. Sounds above 85 decibels cause damage. Those below 75 decibels rarely cause problems. The humming of a refrigerator is 40 decibels, ordinary conversations are 60 decibels and city traffic registers at 80 decibels. Lawn mowers and hair dryers are around 90 decibels and firecrackers explode at 120-140 decibels. After two minutes, exposure to rock concerts (which usually register at 110 decibels) may cause damage. For lawn mowing, the permissible exposure time is sometime between 2-4 hours. The site www.dangerousdecibels.com gives maximum recommended lengths of time for exposure to loud sounds.  

Amongst teens, high frequency hearing loss is on the rise. The exact cause is unclear, but doctors suspect that the loss is secondary to constant exposure to loud sounds. Limit your child’s exposure to high decibel activities. Give your teen earplugs as she mows the lawn this summer and uses the leaf blower this fall.  Because of differences in ear buds and how music is recorded, there is no uniform way to regulate volume produced by MP3 players. However, as a general rule of thumb, if you hear your teen’s music playing when he has ear buds in, it’s too loud. Kids should be able to hear normal conversations even when their devices are on.

So don’t fret if your teenager gets a mosquito ring for his cell. The ringing in the ears after a loud concert or a day of weed-wacking is the “sound” of hearing loss occurring— THAT’s the ring to avoid.

Thanks to Educational Audiologist Kristin Peppiatt, Au.D., CCC-A, the expert advisor who provided information for this post. An Audiologist for Bucks County Schools Intermediate Unit #22 in Pennsylvania, Dr. Peppiatt received her Bachelor’s of Communication Disorders and Masters of Audiology degrees from Penn State University and her Doctorate of Audiology from A.T. Stills University.   She holds her Certificate of Clinical Competency from the American Speech, Language and Hearing Association and is a fellow in the American Academy of Audiology.

Naline Lai, MD with Julie Kardos, MD

©2012 Two Peds in a Pod®

Kinda cute. At least that’s what the medical books lead you to believe.  They are described as little pink or flesh-colored dome-shaped harmless bumps with belly buttons. The little rash with the big name, Molluscum Contagiosum, is cute only until you discover the bumps on your child’s skin. Like your neighbor’s cute toddler, the little belly-buttoned rash can overstay its welcome.

Pictured here is the rash of molluscum. The bumps are generally flesh colored, but can be slightly pink.  Look carefully at the circled bump— this one has a tiny dimple in the center (the “belly button”). While the rash often appears on areas with irritated skin such as eczema, molluscum can show up on every part of the body. As with any new rash, visit your child’s doctor to confirm the diagnosis.

The best thing about molluscum is that it is not harmful. Children can attend school and camp with it. Yes it looks funny, but like warts, it is a virus that is only skin deep. Also, like warts, it can be very stubborn about going away. Probably because it is so benign, children’s immune systems don’t get excited about an out-cropping of molluscum and do not bother attacking the rash.

Welcome to summer! Some seasonal topics to read up on: a germ that lurks in pool water, itchy rashes from poison ivy, painful ears from swimmer’s ear and how to prevent kids from dehydrating.

Yow!

Although I first cringed when I saw this splinter, it is actually one of my favorite kinds. It’s obvious and relatively easy to remove.

Now that summertime is upon us, many kids will want to run barefoot outside. Have your children wear shoes, especially on decks and docks, in the woods, and even in grass and sand in order to protect their feet. In short, if they are not actually swimming, kids (and adults) should wear shoes outside. Even for those who are careful, splinters have a way of magically embedding themselves in bare feet.

If the splinter is very tiny (too small to grab with tweezers,) seems near the skin surface, and does not cause much discomfort, simply soak the splinter in warm soapy water several times a day for a few days. Fifteen minutes, twice a day for four days, works for most splinters. Our bodies in general dislike foreign invaders and tend to evict them. Water will help draw out splinters by loosening up the skin holding the splinter. This method works well particularly for multiple hair-like splinters such as the ones obtained from sliding down an obstacle course rope. Oil-based salves such as butter will not help pull out splinters. However, an over-the-counter hydrocortisone cream will help calm irritation and a benzocaine-based cream such as Oragel will help with pain relief.

If the splinter is “grab-able”, gently wash the area with soap and water and pat dry. Don’t soak an area with a “grab-able” wooden splinter for too long because the wood will soften and break apart. Next, wash your own hands and clean a pair of tweezers with rubbing alcohol. Then, grab hold of the splinter and with the tweezers pull smoothly in the direction opposite of the way the splinter entered. Take care to avoid breaking the splinter before it comes out.

If the splinter breaks or if you cannot easily grab the end because it does not protrude from the skin, you can sterilize a sewing needle by first boiling it for one minute and then cleaning with rubbing alcohol. With the needle, pick away at the skin area directly above the splinter. Use a magnifying glass if you have to, make sure you have good lighting and for those middle-age parents like us, grab those reading glasses. Be careful not to go too deep, you will cause bleeding which makes visualization impossible. Continue to separate the skin until you can gently nudge the splinter out with the needle or grab it with your tweezers.

Since any break in the skin is a potential source of infection, after you remove the splinter, wash the wound well with soap and water. Flush the area with running water to remove any dirt that remains in the wound. See our post on wound care for further details on how to prevent infection. If the splinter is particularly dirty or deep, make sure your child’s tetanus shot is up to date. Also, watch for signs of infection over the next few days: redness, pain at the site, or thick discharge from the wound are all reasons to take your child to his doctor for evaluation.

Some splinters are just too difficult for parents to remove. If you are not comfortable removing it yourself of if your child can’t stay still for the extraction procedure, head over to your child’s doctor for removal.

Now you can add “surgeon” to your growing list of parental hats.

Julie Kardos, MD with Naline Lai, MD

©2012 Two Peds in a Pod®

My youngest child clambered off the bus Friday afternoon with a fixed grin across his face.

 “What are you doing here?” he asked curiously. Usually, I am not home in time to greet the afternoon bus.

“I came to walk you home from the bus stop and then go for a run,” I said beaming, and kissed him on the forehead.

As my son stiffly kissed me back, the strange fixed grin remained on his face.  Then I noticed his hands were behind his back. With a sly glance, I saw he clutched a crinkled brown paper bag. I smiled. Hidden crumpled paper bags close to Mother’s Day mean only one thing — a “surprise” gift.

“Don’t you want to go running now?” my son asked as we walked up our driveway, carefully rotating his body so that he continued to face me.

“Yes, good idea” I said, and resisted the temptation to look back.

As I jogged through the neighborhood, I mused over the upcoming holiday and what it meant to be a “happy” mother on mother’s day. Last week I had gained some insights after participating on a panel at Brown University’s Women’s Leadership Conference. The topic of the discussion was “Happy Kids/Happy Parents: What’s the Secret Sauce?” The talk was lively, and since it was a women’s conference, discussion focused on motherhood. Ultimately the conclusion made by moderator Clare Hare was “There is not one right way to parent,” but, perhaps, some good guidelines. Here are some ideas to think about:

On the dilemma of working outside the house vs. working full time as a mom at home: As a mom it is easy to give, give, and give so much of yourself to others that you can lose a little (or a lot) of your own self-identity. By maintaining a self-identity you become a more confident mother. Some women draw confidence from forging a career outside the home. Others draw from organizing local community-based activities. A mom ultimately needs to feel at the end of the day that she raised her own child, no matter how she does it. Stop comparing yourself to others and do what is right for your own family. In an economy where it is often not financially feasible for one partner to stay at home, working outside the home may be less of a choice and more of an obligation; however, the crucial point remains— if you are not the person you want your child to see, then become the person you want her to see.

On helicopter parenting: Worried that you are too much of a helicopter parent? Know where to draw the line. Use the “cry now or cry later” philosophy. If you know your child will be crying in 30 years when he is obese and diabetic because you didn’t insist on a healthy diet with limited “junk”, stand your ground and let him cry now and you refuse him a second helping of cake. If you know your child will NOT be crying in 30 years because you didn’t insist that he continue piano lessons, let it go.

On keeping you and your child sane during the college admission process: Yes, statistically it’s tougher than ever to get into colleges- this is a matter of demographics. There are more college-bound seniors because of population growth, and hence more applicants per spot. But the pressure for students to overextend themselves in multiple activities is imposed by parents and the kids themselves, not by the admission offices. In the years preceding applying to college, encourage your child to concentrate on excelling in specific areas—think quality not quantity. Do what comes from the heart. When your child seems overwhelmed, as Dr. Kardos and I always say, insure basic needs are met — eat, sleep, drink, pee and poop. And don’t forget to leave time for play and relaxation.

On ignoring hype:  Be willing to change your opinion in light of data. Use evidence, not hype, to drive your actions. Despite data showing teens naturally awaken later in the morning than younger children, one audience member recounted how she still encountered many difficulties when she advocated for later high school start times in her school district. 

All thoughts to nosh on.

You never realize the soaring magnitude of your own mother’s love until you meet your child. No matter your approach to raising children, we wish you “happy” as you remember how you felt when you were the child who brought home a brown crinkled paper bag to surprise your own mom. And again “happy” as you feel gratitude and awe for the privilege of now receiving the surprise.

Dr. Kardos and I wish you a Happy Mother’s Day.

Naline Lai, MD

Special thanks to my fellow panelists: Clare Hare, Principle of Clare Hare Design; Jill Hereford Caskey, Director, Alumni College Advising Program, Office of Alumni Relations, Brown University; Judith Owens , Director of Sleep Medicine, Children’s National Medical Center; Peg Tyre, Director of National Advocacy, Edwin Gould Foundation, author of The Trouble With Boys and The Good School.

© 2012 Two Peds in a Pod®