Rash On The Upper Thighs

     There is a rash that is a red or tan, flat, blotchy rash that occurs on the upper thighs of older children and adolescents. It doesn’t hurt, doesn’t itch and causes no skin breakdown. It occurs without any other symptoms of illness. Doctors describe it as “reticular” which means “net-like”. It looks like someone placed a net on the skin and then lightly sprayed pink paint over it to create a “net-like” pattern.

     This rash is caused by the mild heat trauma created by a laptop computer being continually held on the thighs. The computer generates just enough heat to create skin changes without actually causing burns. Because of the way most laptop computers are designed, the rash is more common on the left thigh. The heat causes the blood vessels to enlarge which causes the pink discoloration. If you push on the rash, you push the blood out of the vessels, so the rash disappears and returns when you let up the pressure. With prolonged heat exposure, the skin can also lay down pigmented cells that will give a tan discoloration to the area and may increase the risk for later skin cancer, just as sun exposure can. If the child stops placing the laptop on his thighs, the rash usually will slowly go away.”

     As children and adolescents use more hand-held devices, this rash may disappear in medical history, perhaps to be replaced with “texting thumb” or “I-pad index finger” injuries.

Trampolines

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     In 2012, the American Academy of Pediatrics issued a policy statement about recreational trampolines that all parents should be aware of.

     Trampolines are used in structured training programs for a number of different sports. In that setting, the use of trampolines is closely monitored for safety. Trampolines used in private homes or used in trampoline parks often vary greatly in quality, safety features and supervision. The Academy’s statement listed the injuries that can occur with trampolines and gave some suggestions for decreasing risk, but the final conclusion was still to strongly discourage recreational use of trampolines.

     It is recommended that all trampolines have enclosures to decrease the risk of falling off the trampoline along with having padding for the springs and frames. These need to be installed properly and checked for wear frequently. The Academy warned that these “safety features” may create a false sense of security because they do not stop the severe injuries that can occur on the mat itself.

     Injuries were more common in children under 5, especially when they were allowed to jump with older children. The force of the other child bouncing can cause the mat to be as firm as if the younger child was falling on solid ground. Even without falling off the trampoline, young children can sustain fractures of the legs and arms. The recommendation was to only allow one child at a time to use the trampoline. Be especially careful when allowing children under 5 to use a trampoline or avoid allowing those very young children to use the trampoline at all.

     The most serious injuries were injuries to the head and neck that caused permanent, catastrophic neurologic damage. These usually occurred when the child was attempting somersaults and flips. Children, especially teenagers,, naturally want to attempt these moves, and it is up to the adult to strictly prohibit them from doing so.

     Trampolines pose such an increased risk that many homeowner’s insurance policies require the owner to purchase a rider on the policy to cover trampoline injuries.

     In short, the use of recreational trampolines is strongly discouraged. Children and adolescents should only be allowed to use trampolines as part of a sports training program that uses all necessary precautions including systems of ropes or cords to safely teach somersaults.

The Child Who Has Many Infections

     When a child has multiple infections and is placed on antibiotics often, it is common for parents to be concerned that there might be something wrong with the child’s immune system. Some normal children have ear infections, sinus infections and even pneumonia in the first few years of life, although children who have recurrent cough and congestion often have asthma or allergies as the cause of their recurrent cough. But the possibility of a child having something wrong his immune system is often a concern in the parent’s mind.

     For decades, doctors considered 10 warning signs that might suggest a child has an immune deficiency. Those ten signs are: more than 4 ear infections in a year; 2 serious sinus infections in a year; 2 months of oral antibiotics without curing the symptoms; 2 episodes of pneumonia in a year; poor weight gain and growth; recurrent skin abscesses; repeated fungal infections in the mouth or on the skin; an infection that needs intravenous antibiotics; 2 severe infections such as an infection of the blood called septicemia; having a history of immune problems in the family.

     A study published in Pediatrics in May of 2011 looked at children with immune system problems and found that the most important of these warning signs were these three:

1.     Having a severe infection which required intravenous antibiotics

2.     Poor weight gain and growth

3.     Having a history of immune problems in the family. 

     About 90% of children with an immune deficiency were identified by having at least one of these three signs. If a child has any one of these three signs, the child should be looked at closely to determine if an immune system problem is present.

Blue Hands/Blue Feet

     A frightening problem common in adolescents is a blue discoloration in the hands or feet - usually the fingers or toes. Fingers are affected more often than any other body part. The area becomes blue and, after a while, may become red. The area may feel cold and tingling, and pressure on the area can cause pain. This is called Raynaud phenomenon. It results from a severe constriction of the arteries in the extremity that causes decreased blood flow to the area.  The decreased blood flow is what causes the blue discoloration. A secondary enlargement of the blood vessels is what causes the redness.  Normally, the vessels in our extremities constrict as a response to cold but Raynaud phenomenon is an exaggerated constriction, sometimes with only minimal exposure to cold and sometimes as a response to stress. It can sometimes begin in a stressful time in an adolescent’s life. It can also be triggered by smoking or caffeine consumption.

     The most common form of Raynaud phenomenon is called primary and it is not usually associated with other complications such as skin sores or blisters. The blue discoloration gradually resolves as the vessels re-expand. Warming the extremity can speed up the recovery. It is sometimes treated with pain medications for comfort and other medications to decrease the amount of vessel constriction.

      Although Raynaud phenomenon is usually not a severe problem, it is important to have the child's caregiver investigate it to ensure it is not associated with more serious diseases. This can involve blood tests, X-rays and even referral to specialists.