What to Expect the Toddler Years (162 page)

Atopic dermatitis
(eczema).
What is it?
The most common skin condition in children under eleven, it has been aptly described as “an itch that rashes.” Once the itch begins, scratching or rubbing the area triggers the rash.
Who is susceptible?
Most often, children with a family history of eczema, asthma, or hay fever, or a personal history of allergy. A majority of cases begin in the first year and almost all by age five.
Signs and symptoms:
The itching comes first, sometimes with night waking and crying, face rubbing against crib sheets (crib may shake as child tries to soothe the itch), scratching (sheets may become blood-stained). As the infant or child scratches or rubs the area, bright red scaly patches appear, most often on the cheeks and wrists in infants and young toddlers, and in body creases and folds (at elbows, knees, thigh/groin area) in those over two. It may also spread to the diaper area. Often the skin thickens and in dark-skinned children, it can produce additional melanin as a protective measure, making the thickened patches look black (hyperpigmentation). Sometimes the rash becomes weepy. Secondary infection, usually with staphylococcus, is common. The papulovesicular lesions (they look like small pimples, or papules) erupt, fill with fluid, then weep and crust over, intensifying itching. Though most children “outgrow” the eczema, they may continue to have sensitive skin as adults. These children are also at extra risk of developing asthma or nasal allergies later.
Causes:
Numerous factors are believed to trigger the itching (most often in children who have inherited a sensitivity) including: dry skin (the major factor), heat or cold exposure (often at change of season), perspiration, wool and/or synthetic clothing, friction, soaps and detergents, certain foods (most often eggs, milk, wheat, peanuts, soy, fish, shellfish, and chicken), and, possibly, inhaled allergens (pollens, dust mites, mold).
Transmission:
Not communicable, though secondary infection of the rash may be.
Treatment:
Medical attention is
essential
: treatment usually includes steroid creams for inflammation, antihistamines for itching (especially to help a child sleep), and antibiotics if secondary infection develops. Skin testing and elimination diet will be recommended if food allergy is suspected. On the home front, it is important to: clip your toddler’s nails to prevent scratching; avoid showers, which are particularly drying; limit baths to five minutes three times a week or add a soothing colloidal oatmeal bath product to the bath water; use no soap on affected area; use Dove or other gentle soap (see page 465) elsewhere as needed, and instead of shampoo; ban swimming in chlorinated pools and salt water (fresh water is okay); apply any doctor-recommended lubricating skin ointment generously, but do not use vegetable fats or oils; minimize exposure to extremes in temperature,
indoors and out, and to dry air indoors (use a humidifier in winter; see page 838); dress your child in cotton (rather than wool or synthetics) and avoid scratchy or potentially irritating clothing; protect your child from germs that might infect the open sores by observing scrupulous hygiene practices (see page 609) and being sure that caregivers in any preschool or other group your child attends do likewise; eliminate any food or environmental factor that triggers a breakout (see page 706). Keep in mind that a nutritious, well-balanced diet can also help keep your child’s skin clear and healthy.

Impetigo.
What is it?
A bacterial infection of the skin.
Who is susceptible?
Mostly young children.
Signs and symptoms:
With “staph” infection, large, thin-walled blisters that burst and leave a thin yellow-brown crust. With “strep,” a single painless fluid-containing vesicle surrounded by reddened skin develops—often around the nose, mouth, or ears. It may then begin to weep, oozing yellowish fluid, which forms a yellowish crust. It can spread quickly to other areas of skin.
Causes:
Bacteria, such as streptococci or staphylococci, entering the skin through a break, such as a scratch, bite, irritation (e.g.: diaper rash). Both bacteria often infect the same lesion. Very rarely, strep impetigo spreads to the kidneys or staph impetigo causes endocarditis or osteomyelitis.
Transmission:
Person-to-person; contagious until the rash is gone or until medication is taken for 48 hours and rash improves.
Treatment:
Medical treatment is necessary;
do not
self-treat. Topical antibiotics and hot soaks are usually prescribed for very mild cases (a superficial lesion), oral antibiotics (broad-spectrum type, effective against both strep and staph is best) for multiple lesions.
Prevention:
Avoiding anyone with an active infection; thoroughly cleaning mild skin wounds with soap and water, and then applying an antibiotic ointment.

Prickly heat.
What is it?
Heat rash.
Who is susceptible?
Most commonly, babies; but toddlers, children, and even adults can develop a heat rash.
Signs and symptoms:
Tiny pink pimples on a reddened area of skin; they may blister and then dry up. The rash occurs most often around the neck and shoulders, but it can also appear on back and face, or anywhere skin rubs against skin or clothing constricts.
Causes:
Overheating, overdressing.
Treatment:
Smoothing on cornstarch or adding cornstarch to the bath; dabbing on a solution of 1 teaspoon bicarbonate of soda to 1 cup of water with cotton balls may also be soothing. But avoid products containing talc, which can cause respiratory problems when inhaled.
Prevention:
Protect your toddler from overheating by keeping indoor spaces as cool as possible. (See the tips on dressing your toddler for warm weather on page 499.)

Ringworm of the body
(tinea corporis).
What is it?
A fungal infection of the skin.
Who is susceptible?
Anyone.
Signs and symptoms:
Itchy, scaly red patches that grow into red round or oval “rings” surrounding a smooth center.
Causes:
Various types of fungi.
Transmission:
Direct contact with infected people or animals, or items handled by infected individuals.
Treatment:
After diagnosis by examination and, generally, a culture of scrapings from a lesion, topical antifungal medicine is usually prescribed. If the rash doesn’t begin to clear in two weeks, an oral preparation may be prescribed. As with other medications, medication for ring-worm must be continued for the prescribed period, even if the rash clears sooner.
Prevention:
Avoidance of contact with infected persons or animals, and with any objects they may have handled or touched.

Whether it’s a mass of ringlets or a fine coating of down, every toddler’s hair needs some care. Since most toddlers (and their parents) dread hair care routines, it makes sense to limit them to the bare essentials:

Choose gentle supplies.
Think “gentle” when you select brushes and combs for your toddler. A brush should be flat, rather than curved, and have bristles with rounded ends. If your child has tight, curly hair, the bristles should be long, firm, and widely spaced. A comb should have widely spaced, nonscratchy teeth (check for smoothness by running the comb across your inner arm, which is more sensitive than your hand). A wide-tooth comb is especially important for children with extra-thick or frizzy hair. A detangling comb, specially designed for tight, curly hair, is also useful.

Think “gentle,” too, when choosing a shampoo; a mild, no-tears formula that is designed for children is best. Shampoo/conditioner combinations save a step, which makes them perfect for shampooing a squirming toddler. Alternatively, use a children’s shampoo plus a spray-on detangling rinse after the shampoo, instead of a conditioner that requires extra rinsing.

Care for hair gently.
Brushing helps to bring oil to the surface of the scalp and is particularly valuable for children with dry hair. But don’t brush hair when it’s wet; comb it, instead. Use a light touch when brushing or combing your toddler’s hair; avoid tugging or yanking. Detangle with a wide-tooth comb, working from the ends up, one section at a time; keep a bottle of spray-on detangling rinse around for resistant snags. To prevent hair breakage and loss, don’t pull hair tightly, whether in braids, barrettes, or ponytail holders, and never use regular, uncoated rubber bands (use only the soft-coated variety made for hair use). For tips on dealing with the toddler who rejects the comb and brush, see page 276.

Because most African-Americans have hair that breaks easily, be especially gentle when brushing. Start at the nape of the neck and work toward the tips. Do small sections of the hair at a time. Brush downward, rather than up, because brushing up is more likely to break the hair.

Shampoo only as needed.
Since oil glands on the scalp, like oil glands elsewhere, don’t become fully functional until puberty, daily shampoos are rarely necessary, except for toddlers who tend to get a lot of food, sand, or dirt in their hair, or those who have particularly oily scalps. Many toddlers—especially those with very dry hair or scalps—do well with only a weekly shampoo. Others require a shampoo every other day or even every third day. More frequent shampooing is often needed in summer, when hair gets sticky faster. Be sure to rinse well; a soapy residue can become a magnet for grime. For dealing with a shampoo rebellion, see page 153.

Don’t share when it comes to hair.
Most of the time, the ability to share is an admirable trait to encourage in toddlers; but when it comes to hair care equipment, sharing isn’t a virtue. Each member of the family should have his or her own comb and brush, and to prevent transmission of head lice or other problems, should keep these to themselves. Combs and brushes should be washed weekly or every other week in suds made with a dash of shampoo and warm water.

Hair loss
(alopecia).
What is it?
Abnormal loss of hair.
Who is susceptible?
Anyone, but young children are less susceptible to certain types of hair loss and more susceptible to others.
Signs and symptoms:
It’s normal to lose about 40 to 100 hairs a day (more on shampoo days), each of which is replaced by a new hair. But if your child suddenly begins to lose fistfuls of hair and/or develops a bald spot, check with the doctor.
Causes:
A fungus infection, such as ringworm (common in young children; see this page); an underlying medical illness, such as thyroid disease; or alopecia areata (suspected to be an allergic reaction to one’s own hair; rare in young children). But balding could also be the result of poor nutrition, stress (though stress-related hair loss is uncommon in toddlers), habits like head-banging (a bare spot develops where the head repeatedly makes contact; see page 117) or hair twisting or pulling or “traction alopecia” (from fastening hair too tightly in barrettes, braids, or ponytails, or pulling it excessively during combing or brushing).
Transmission:
Depends on the individual condition (see below).
Treatment:
Depends on the cause: Ringworm is treated as described in the following section; a thyroid condition is treated with appropriate medication; and since about 90% of alopecia areata patients have complete regrowth within a year, it is generally left untreated (except in severe cases, the condition is self-limiting). Traction alopecia can be reversed by avoiding barrettes, braids, and other hair styles and accessories that pull at the hair. What ever the reason for hair loss, keep in mind that the body needs adequate protein intake to restore hair growth.

Ringworm of the scalp
(tinea capitis).
What is it?
A fungal infection of the scalp.
Who is susceptible?
Anyone, but children between the ages of two and ten are the most vulnerable.
Signs and symptoms:
Thinning hair and balding spots on the scalp, with flaking and itching. (In toddlers, the flaking raises a strong suspicion of ringworm, since young children are unlikely to have either cradle cap or dandruff.) If there is hyper-sensitivity to the fungus, hair follicles may become inflamed; there may also be blistering, cracking, and tenderness. Some children experience a severe inflammatory reaction, with fever and swollen glands. Ringworm may be confused with other scalp problems, so medical diagnosis is necessary.
Cause:
A fungus, most often
Trichophyton tonsurans
, which infects the hair shaft itself.
Transmission:
Via personal contact, as well as brushes, combs, and barber/hairdresser instruments.
Treatment
: An anti-fungal medication for four to eight
weeks combined with a shampoo containing 2.5% selenium sulfide. (The shampoo alone is not effective.)