Tag Archives: rash

The Chickenpox/ Shingles Story (Pedcast)

Voice introduction

I was having a discussion the other day with the mom of one of my patients. She was asking me why we vaccinate children against chickenpox; a disease that her mother told her was a benign mild childhood illness that doesn’t hurt kids.  Keep in mind that almost none of the parents of my current patients have ever seen or had any experience with the disease of chickenpox.  The disease is virtually gone in the United States so everything parents know today is based on what they have heard.  This particular mom had so many questions and a few misconceptions about chickenpox. Because of this I thought many of my blog listeners probably have many of the same questions, so today were going to talk about the disease known as chickenpox: the myths and facts and the rationale behind vaccinating today’s children. Why do we bother vaccinating for a harmless childhood illness? Continue reading

A Dangerous Rash in Children (Pedcast)

Here we go with another edition of DocSmo. Com…the podcast for parents on the go. Portable, practical pediatrics for modern parents.  Thank you for joining me today.  I hope you are having a wonderful day. One of my phone triage nurses the other day asked me if I would do a podcast that could help her know when to bring children into our office who have skin rashes, particularly rashes that might be a sign of a serious disease.   I explained to her that rashes over the phone are really difficult because the parent who is describing the rash usually has no experience describing rashes… no skin vocabulary so to speak. Given that limitation, her goes my attempt at helping phone nurses and parents know more about a one specific rash of the skin called a petechia that can indicate serious disease.

Before we get started with today’s talk, I have a confession to make… the truth is that it’s just as difficult for doctors to describe rashes in an accurate way as it is for parents to tell us about rashes over the phone.  I will do my best, you know I always do, but if you have any concerns about your child’s rash, health, well being etc., please consult your pediatrician directly and let them LOOK at his or her rash.  Seeing is so much better than describing!!!!

OK, lets get specific.  First you need to learn something about petechia.

Petechia are really small bruises in the skin. They form when blood leaks out of small blood vessels in the skin. They tend to be darker than most skin spots and cannot be felt, they are deeper in the skin than most other skin spots. Since they are bruises, they change color as they age starting red in color and gradually turning a brownish color.  When you push down on them, they do not disappear like most red spots in the skin.  Repeat.  This is crucial that you know.  This is how they are distinguished from other red spots of the skin.

So what causes petechia you ask?  Good question. Since they come from blood leaking out of blood vessels, anything that causes vessels to leak can cause them to form.  Mostly, this falls into one of 3 categories:

-Trauma-scratching, vigorous rubbing, or increased pressure inside delicate vessels.

-Infections of blood and blood vessels- Microbes literally damaging vessels and making them leak

-Lack of cells called platelets in the blood that stop leaks in small vessels. These are called platelets.

OK so now you know what a petechia is…its time to put this to use.  Imagine you are now a triage nurse and parents are calling in telling you about their sick children.

Here is your first call on line 1 – A mom calls about her 6 year old who has been tired and pale for about 2 weeks. She says she now sees a dark rash, little dark red spots all over.  You recognize her description as petechia and suspect leukemia.  Petechia can be associated with very serious illness and almost always mean a visit to the doctor. This decision is an easy one for the triage nurse; this child comes to the doctor immediately!  You turn out to be right, the child does have leukemia but this child ends up doing well, being cured like most children with leukemia today.

2nd call- The next line you answer is a Dad who tells you about their 12-year-old boy scout who has had a fever, a bad headache, and now a rash that sounds like petechia… what to the Dad looks like bruising on the skin.   Fever and any rash means a doctor visit but fever and petechia is a medical emergency.  You direct them to the ED where the child gets admitted with Rocky Mountain Spotted Fever. Petechia  are the beginning of the “spots” in RMSF. Good call phone triage nurse.

Line 3 is a Mom and child you know well… Little Janie has eczema and her mom calls all the time.  Janie has been scratching a lot recently and Mom has noticed some tiny red spots in areas where she has been scratching.  You suspect these are petechia, but since she is not sick and has been scratching, you decide to just bring her in for one of the doctors to see.  They confirm your suspicion…scratching petechia. .. totally benign.  Her eczema regimen is tweaked and the rash disappears in 2 weeks.

You are on a roll and are feeling fairly confident of your skin acumen so you go ahead and answer line 4. The Mom on this line tells you about her 3 year old who has what she believes is a stomach flu.  She has been vomiting all morning and she has a fever of 102. Mom has noticed some red spots around her eyes that don’t blanch with pressure.  Her face is the only place she sees the rash. You are pretty sure they are petechia!  Now it’s decision time.  The last call was sort of the same, fever and petechial rash and that child had a life threatening illness.  Should I send this one to the ED as well?  No you decide.  You know that vomiting a lot can cause petechia in a non-

serious way so you decide to bring them into the office for a visit instead…. Right. This child turned out to just have pressure petechial from straining with vomiting.  This is not serious and she turned out to just have stomach flu after all.  Mom was absolutely right.

So you get the idea. You need to consider the context of any spot to have an idea of what is wrong. Your child can get petechial rash from wrestling with Dad, but in the context of paleness and fatigue…that’s leukemia until proven otherwise.  Remember, rashes that appear during illnesses are usually significant and important.  Make sure you learn to recognize the important rash of petechial in children.

I hope that helps your knowledge base. Listen out soon for another in my skin series on hives.  Understanding them will really help your parenting skills. If you like pedcasts, take a second to write a comment on my website, www.docsmo.com or a review on iTunes.   This is Dr. Paul Smolen, your pedcast host, broadcasting from studio 1E, hoping you will can describe your child’ next rash in a flash. Until next time.




Poison Ivy-Just Leaf it alone! (Pedcast)

Camp Essentials continues with some “must know” facts about the most common contact dermatitis, poison ivy. Learn some burning facts that parents have been itching to know. In this episode, Dr. Smolen gives parents the Must Know facts to keep their children away from the summer misery called poison ivy.


For more information about camp essentials, check out the topic of the week!


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Changing Diapers; Hazardous to Your Health? (Pedcast)


Just imagine this Norman Rockwell scene– a baby’s room, a changing table, and powder everywhere with a giggling baby kicking and enjoying being liberally powdered. The baby has a nice dry bottom and is enjoying the nice aroma of the powder not to mention the wonderful feel of powder on their skin. What could be more American and traditional?  Grandma’s of yesteryear loved baby powders because they were super absorbent and feel great. Unfortunately, there is a dark side to powders that you should know about! There are things all parents need to know about baby powder, which we are going to discuss today. Before you start sprinkling powder around your baby and yourself, take a listen to this pedcast and learn why the use of baby powders are controversial and potentially harmful to you and your baby! Welcome to another edition of Portable Practical Pediatrics. I’m your host, Dr. Paul Smolen, a board certified pediatrician with a lot of experience and a whole lot to say.

What are powders?

Powders are created when solid substances have been crushed, ground, or pulverized into very small particles.  When these dry small particles are collected they are called powders. I guess it is possible to make a powder out of any solid substance and they can have many varied uses; from makeups to lubricants like graphite all the way to cocaine and gunpowder. Powders are amazing things! Today, we are going to limit our discussion to baby powders, the kind that are used on a baby’s bum. Chemically, baby powders are usually made of either talc, a mineral mined in many locations in the U.S. or from cornstarch. When it comes to powders the smaller the particles, the higher the quality of the powder. That’s why talc was so valued as a powder–talc can be pulverized into very small particles. It makes the best powder!  The small size of the particles creates a super-large surface area to absorb lots and lots of moisture. The ultra small particles also give this powder a silky smooth feel that both moms and babies really enjoy.  The powder keeps junior’s bum dry, silky smooth, reduces the friction of the diapers, and absorbs chemical irritants in their urine and poop.  What’s not to love?

If powders work well, what’s the problem?

You know by the title of this pedcast, that there must be a dark side to powders. Well, you are right. Here are some observations that make pediatricians and other health experts worry about people using powders, especially talcum powders around babies.

Workers in talc factories often have lung problems.

Some babies who have inhaled large amounts of powders have had lung problems.

Some naturally occurring Talc has asbestos fibers in it thus creating the long-term concern about lung cancer.

In fact, a jury in 2017 awarded a cancer victim  $100,000,000, finding liability against the Johnson and Johnson Company.

The irony with powders, especially those that contain talc, is that what makes them so useful also makes them more hazardous to use– their small particle size. These very small particles, microns in size, can drift down deep into your and your baby’s lungs and sit there for long periods of time. These particles can provoke allergic reactions, scarring of your baby’s lungs, or possibly even cancers.


How do I Keep My Baby’s Bum in Shape?


Our friends across the pond, the Brits, call diapers Nappies. So how do you keep your baby’s nappies happy? How can you keep the delicate skin on their bottom from breaking down if you can’t use powders? Here are a few tips that can help keep your baby’s bum in good shape:


-Frequent changing of diapers

-Careful cleaning and drying before new diapers put on.

-Avoid chemical wipes

-Remember, babies skin thinner that older people. Be very gentle when cleaning their skin and only use a soft wipe with lots of water.  A soft cotton diaper cut up into squares makes a good cleaning clothe.

-Barrier creams are very helpful keeping irritating poop or pee away from the skin. I love these.

-And of course, avoid using powders. They can be dangerous to your family’s health.


Well, that wraps up today’s pedcast. If you enjoy learning about child health with pedcasts, please take a minute to write a review on iTunes or subscribe to my blog at www.docsmo.com. You can also spread the DocSmo word by hitting the like and share buttons on my Facebook, Twitter, Google+, or Instagram accounts.

This is Dr. Paul Smolen, broadcasting from studio 1E in Charlotte, NC, hoping you are now more aware, of the dangers of powdery air

Until next time






  1. “How Can I Make Sure My Baby’s Bedroom Is Safe?” American Academy of Pediatrics : Healthy Children 10 June 2010: 1. Web. 2 Apr. 2011. <http://www.healthychildren.org/English/safety-prevention/at-home/pages/Make-Babys-Room-Safe.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:%20No%20local%20token&nfstatus=401&nftoken=00000000-0000-0000-0000 000000000000&nfstatusdescription=ERROR:%20No%20local%20token>.


2. American Cancer Society. 04 Nov. 2010. 02 Apr. 2011 .


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All Right’s Reserved.