Kids Love Dr. Barton

Skin Infections

by Dr. Douglas Barton, M.D., Pediatrician 10/22/2009

 A recent experience with a patient reminded me just how important it is to stay “clean.” His case was striking for how severe it was, but similar problems could occur with anyone. He is a football player who got his hand stepped on during a game. The other guy’s cleats ripped a gash in the back side of my patient’s hand. Of course, out on the turf of a football field, there were plenty of germs to go around. He went to an emergency room where they attempted to clean up the cut. The family’s impression was that they spent a lot of time cleaning and clearing out debris. The gash was stitched up appropriately, but over the next twenty-four hours, it became clear that there was an infection brewing. It took us a couple of days of IV antibiotics and another ten days of oral antibiotics to get him cleaned up. He’ll also have quite a scar to impress the girls with. He says it will make him look tough.

While a large cut that has been ground into the dirt is rather dramatic, there really are myriad ways that your children can pick up serious skin infections. The most common that I see in the office is a terribly itchy bug bite that the kids can’t resist scratching until it bleeds. Other skin infections can come from small cuts that aren’t adequately cared for. Another common source is the minor cold. With all that nasal drainage, kids can’t resist drawing their forearm across the nose many times a day creating skin breakdown just under the nose which is a portal to allow bacteria into the skin.

What almost all skin infections have in common is a break in the skin and some contact with an infected surface. So how do you prevent these from developing?  Probably the single most important thing you can do is to teach your kids to wash their hands often. The more often they clean their hands well (vigorous scrubbing for at least 20 seconds), the fewer bacteria will reside on the hands. It is especially important to clean under the fingernails. Fingernails are used for everything! Prying rocks out of the dirt, untying a knot, picking scabs and noses and scratching at itchy bug bites.

Secondly, keep any break in the skin absolutely as clean as possible. With any wound, soap and water should be the first line of treatment. Soap and water can be used on any injury for as long as it takes that injury to heal. Flush with as much water as possible. If it is a dirty cut, an abundant amount of peroxide or Betadine can be used with the first cleaning, but should not be used after that (these two compounds injure healthy skin cells almost as much as they do bacterial cells). If there is ground-in dirt, take the time to scrub out the dirt as much as you can. These small particles of dirt harbor lots of bacteria. Finally, keep an antibiotic ointment on the wound no matter how small or where it is on the body. Neosporin is adequate for most purposes. We will sometimes use prescription strength creams when over-the-counter creams fail. 

Sometimes, in spite of your best efforts, breaks in the skin become infected. Signs that you need to take your child to the doctor include pain, swelling, and redness outside of the immediate injury or pus coming from the wound. Pus is usually thick, white, yellow or green, and often smells bad. Often wounds will drain a clear thin yellow fluid. This fluid is not pus, is actually aiding in the healing, and can be washed off with soap and water. If any drainage persists past a few days, it may indicate a need for further therapy.




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