Squeamish mamas this one’s definitely not for you! Dr. Rania tells us all we need to know about kiddie health issues that might make you squirm – from molluscum to head lice – and how to handle them.
Alongside the various coughs, colds, fevers, tummy bugs, sleepless nights and occasional emergency department visits, our children often have less serious, but more common conditions that we have to deal with on a day to day basis. Today, I’d like to wade into the icky, sticky, scratchy and somewhat disgusting world that is warts, worms, head lice and everything (not so) nice!
Most of these are spread by direct or indirect contact with a person’s body secretions, such as saliva, nasal/throat secretions or infected faeces. Others are spread through contaminated water and caught by ingesting the organism, and others still are transferred by direct skin to skin contact or contact with a contaminated surface.
Pink eye, or conjunctivitis, is an infection of the tissues on the inner surface of the eyelids and those covering the eyeball. It’s very common in children, especially those under the age of 5. It often begins with itchy, red or “pink” painful eyes, and the child may then develop significant eye swelling and discharge. This discharge can range from being very mild and white in colour to being copious, thick, sticky and green. Children often wake up with very swollen eyes with the lids stick together and crusted over.
This condition is very contagious and can be passed easily to both children and adults alike, simply by touching the infected eye and touching their other eye or that of another person. It can also be passed on through washcloths and other contaminated items such as eye drop applicators.
The incubation period is from 1 to 3 days and a child is contagious as long as he or she has the symptoms. If antibiotic eye drops or eye ointment are started, the child is no longer contagious after 24 hours of treatment but must of course complete the prescribed course of medication. This is an excludable disease and if your child is discovered to have conjunctivitis at school or nursery, you will be expected to pick them up and keep them at home until the symptoms have subsided or for at least 24 hours after starting treatment.
The best ways to prevent this infection is to avoid contact with those who have it, regular hand washing and to discourage children from sharing towels, face cloths and other potentially contaminated items, even within the same home.
Ringworm is an infection of the skin that causes a characteristic rash, shaped like a ring, hence the name. It is not cause by a worm at all, but by a fungus. It can be found on several parts of the body, including the scalp, groin and feet. The rash is often red, raised, scaly and itchy and it can sometimes be wet and crusted over, especially if there’s a secondary infection.
Scalp ringworm can lead to areas of hair loss, and is very contagious. Ringworm on the feet leads to symptoms of athlete’s foot, and is more common in teenagers. It causes itchy, malodorous feet with scaling and possibly blisters. Ringworm on the skin can be cause from touching the skin of infected individuals or can even be spread from affected animals such as dogs or cats. Scratching one affected area can lead to spread to other areas of skin, as the fungus survives under the nails. The fungus can also survive for long periods of time on clothes, towels, tiled surfaces such as showers and swimming pool areas. Incubation period can be as long as 2 weeks, and a person is contagious as long as the lesions are present. Treatment is with antifungal preparations such as creams or washes, and if the rash is extensive, oral treatment may be necessary.
Ringworm can be prevented by regular hand washing and avoiding sharing items such as towels and hairbrushes. Children should also avoid contact with potentially infected animals.
Warts and Verrucas
Warts are raised skin lesions, caused by a virus that infects the skin through a scratch or small cut. When these are found on the soles of the feet, they are called plantar warts, or verrucas. They are found most often in children and teenagers as most adults have already developed an immunity to the virus. They look like dry, raised, hard bumps, often with a darker centre or several darker dots on the surface. In areas of pressure, such as soles of the feet, standing and walking can cause the verrucas to dig into the skin, thus causing pain. Warts can also be found anywhere else on the body, such as fingers.
Warts are contagious, and are often caught from contaminated surfaces such as shower tiles and swimming pool areas. The incubation period can be several months and the wart is contagious as long as the lesion is present.
There are several over the counter remedies for this, such as salicylic acid preparations. Warts are often ‘frozen or treated with cryotherapy by your doctor or dermatologist. Depending on the size of the wart, more than one session may be required.
Prevention is best achieved by avoiding contact with contaminated surfaces (wearing flip-flops in showers for example) and avoiding scratching or touching an active wart.
You’re probably starting to scratch your head as you read this. The mention of head lice does that to most people. Head lice are tiny insects or parasites that make our scalp their warm and cosy home. They live off tiny amounts of blood that are drawn from the scalp. Nits are the eggs, and are the first stage of a head louse’s life. They are small whitish, yellow translucent ovals found stuck to the hair follicle, usually behind the ears and at the back of the neck. They usually hatch 10 days or so after they are laid. Adult lice are small, around the size of a sesame seed and are very difficult to see as they move fairly quickly around the scalp.
Head lice is not an infection, but an infestation. It causes an itchy scalp and sometimes a reddish rash, or scratch marks can be seen. Often, the infestation is asymptomatic. The best way to confirm the diagnosis is to see adult lice, and the most effective method to do this is by using a fine-toothed lice comb.
Nits and adult lice can survive 2 to 3 days away from the scalp, on items such as hats, combs, brushes and pillows. Lice cannot fly, so direct contact is often needed for infection. As you can imagine, direct head to head contact is extremely common in a nursery or primary school setting. For this reason, head lice is not an excludable disease but treatment should be started as soon as the infestation is discovered and contacts are informed.
There are several over the counter head lice shampoos and lotions which are effective. Bedsheets, clothes and other items need to be washed in hot water if possible, or stored in a freezer for 48 hours if not.
Prevention is achieved through avoidance of head to head contact with affected individuals and sharing of potentially contaminated items.
Molluscum contagiosum is a very common rash caused by a pox virus, known as the Molluscum Contagiosum Virus. It is found commonly in children under 10 years old. It causes small, raised pinkish, and often pearly lesions. These are usually painless and harmless but can be fairly itchy. Larger lesions can be seen to contain a central dipped area, which sometimes contains a hard waxy core, in which lies the active virus.
The lesions appear in clusters and can be located on any part of the body, but are usually found on the trunk, groin area and in skin creases such as the neck and axillae. The virus is spread through direct skin to skin contact and self-inoculation is common, through scratching. The incubation period can be up to several months. A rash is contagious as long as the lesions are present.
The lesions in molluscum can last for several weeks to months, and sometimes years, in cases of immunocompromise. Treatment options are usually uncomfortable, so the initial approach is always to leave the rash alone. Other options involve the topical application of over-the-counter wart medications, as salicylic acid, but this is not very effective and needs to be applied repeatedly for several weeks. Other forms of immunotherapy treatments such as Imiquimod (Aldara cream) have been used but found to not be very effective. Curettage (removal of the lesions with a curette) is often used by many clinicians/dermatologists and preferred by patients as it treats most or all of the lesions at once with little need for further visits.
This refers to the infestation of our intestinal tract with threadworms (or pinworms), otherwise known as enterobiasis. These are ingested as eggs, from contaminated water, or those present on surfaces in the environment, shed by another infected individual. The eggs then hatch in the first part of the small intestine (the duodenum) and the larvae make their way down to the colon, where they grow, mate and the female pinworms lay more eggs. This process takes 5 to 6 weeks from first ingestion of the egg. Threadworms can grow up to 10 or 15cm long!
The first symptoms of threadworm infestation is itching in the anal area. This is due to the fact that the female worm emerges from the anus, in order to lay the eggs in the perianal skin, as they need oxygen to mature. This causes intense itchiness in the perianal and groin area, mainly at night, along with difficulty sleeping. Some children complain of abdominal pain, poor appetite, and may experience weight loss. Worms can sometimes be seen in the stool.
Treatment is with mebendazole (Vermox), where one dose is taken on the day of commencing treatment, and a second dose is taken two weeks later to eradicate any newly hatched worms. Care must be taken to treat all members of a household, in order to prevent recurrence, as well as washing and cleaning all potentially contaminated surfaces.
In several settings, prevention is usually achieved by annual or biannual treatment with mebendazole, just in case.
There are several other less common similar conditions and infestations that you may come across during your and your child’s day to day life. Most of these are prevented with regular hand washing and basic hygiene, as well as avoidance of obviously infected individuals. The important thing to note here is that, none of these conditions are dangerous as such. They are mostly annoying and inconvenient, as well as, dare I say it, pretty disgusting, but they form a fairly common and expected part of a child’s paediatric journey.