Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital
Rabbi L. from Kiryat Sefer asks me how should a parent deal with a child who has fallen and struck his head.
This unfortunately is a difficult question to answer. Certainly, a child who is unconscious, confused, or lethargic, requires immediate attention. The problem is with children who fall and are not unconscious or sustained only a very brief period of unconsciousness. Most of these children will do well and require just that the parents keep a close eye on them at home. That means rest, avoiding activities that could result in another knock on the head, and watching for seizures, lethargy, altered breathing, or vomiting that just won't stop. One or two episodes of vomiting is not a sign of danger.
You can let your child fall asleep. Whether or not you need to wake him or her in the middle of the night is debatable. Most physicians still recommend that you do wake a child just to see if he is able to recognize you, but there has been research out of North Carolina that just turning on the light and observing how he breathes is sufficient.
The problem is that most of these recommendations are based on studies done in the U.S.A., where most homes are carpeted and most falls outside occur on grass. In Israel stone is everywhere, and therefore we can not tell you for sure that what is good for the U.S.A. is good for Israel.
My colleague Dr. Amir from Schneider Children's Hospital is currently studying this issue; in the interim, she recommends physician evaluation if a child vomits more than three times, has lethargy, or loss of consciousness for more than a very brief period of time.
Children under one year of age are harder to evaluate, so don't be surprised if your physician is a lot more aggressive in this case.
Let me say once again what I have been saying all along to everyone: Children in cars must wear seat belts, and children on bikes must wear helmets. I have already seen too many tragedies.
I had the wonderful opportunity to meet the Gee family of London over Simchas Torah, and I wanted to tell them how nice it was of them to tell me how they enjoy this column in Great Britain. I promised them I would write a few words about erysipelas, also known as St. Anthony's Fire. This is an infection of the skin which presents with a red hot plaque, with well defined borders. Usually there is abrupt high fever. In the past, this infection was common on the face, now we see it more on the legs.
The usual cause is a bacteria called strep, and it usually responds to antibiotics, but this bug, for reasons unknown to us, can sometimes turn mean, and become a "flesh eating" bacteria. This is a much more serious disease, and patients require immediate surgery. Basically, any hot painful patch of skin requires a doctor's attention.
Some patients can take treatment at home, but the elderly, people with venous disease and diabetics do worse and need hospitalization. Write me in care of the Yated.
