Tips and Tricks in Adoption and Pediatrics

long line.jpg

Hair and Skin Care for African Children

Adopting an African-American child, or a child from Ethiopia or other African countries? If African(-American) hair and skincare is foreign to you, these resources can help:

  • Happy Girl Hair - LOVE this website by a local mom of two lovely twins from Ethiopia, one with tight coils, one with loose curls. Product reviews, and styling/braiding tips from simple to elaborate
  • Adoption Hair and Skin Care, an active, non-judgmental YahooGroup
  • Hair Matters, on RainbowKids
  • African Hair Care, on Creating a Family
  • "Does Good Hair Equal Good Parenting?"
  • Hair Rules, from Adoptive Families (also has Asian and Hispanic hair tips)
  • Chocolate Hair, Vanilla Care
  • One of our families recommends food-grade grapeseed oil for scalp and skin, as it's less fragrant than olive or coconut oil, and both cheaper/purer than the versions in the cosmetic aisle
  • Another family loves Alaffia shea/coconut hair lotion for longer/loose-curlier African-American hair, and recommend infrequent shampoo with daily refreshing: a bit of spray water, followed by this leave-in conditioner.
  • You may also find local hair salons or agency classes helpful for hands-on help

As many of our multi-racial clinic families have learned, the painful way, many adults in the African-American community will view how you do or don't groom your child's hair as a marker for how well cared for they are. Hopefully in a helpful well-meaning way, but even then it's a hard thing to hear. Besides, children need to learn how to care for themselves, often want to "fit in" with others of their ethnicity, and want to look beautiful (or handsome) with the curls and coils they've got. 

Bleach Baths

Sounds horrible, right? Actually, dilute bleach baths have a role in a few pediatric conditions, so I thought I'd share instructions here.

For children with recurrent, sympomatic infections with staph bacteria, particulary MRSA, we use bleach baths, in conjuction with nasal treatment with Bactroban, to decrease MRSA colonization, and reduce infection risk. Here's a handy guide from the Infectious Disease specialists at Seattle Children's. As always, you'll need to check with your provider first, and the Bactroban is by prescription.

In moderate-severe eczema, especially with frequent bacterial infections or colonization (suspected when eczema patches are unusually red, cracked, painful, oozy/crusted), new evidence suggested that regular soaks in dilute bleach baths may decrease the bacterial burden on the skin, and associated inflammation. Check with your provider first, but here's how, from an excellent review article in Pediatrics by Krakowski et al.:

Explain to patients that their skin may benefit from "swimming in pool water." Then, give them these instructions for making a pool right in their very own bathroom.     

  • Add lukewarm water to fill the tub completely (about 40 gallons of water).
  • Depending on the size of the tub/amount of water used, add 1/4 to 1/2 cup of common bleach solution to the bath water. Any sodium hypochlorite 6% solution will do (for example, Chlorox liquid bleach); the goal is to make a modified Dakin's solution with a final concentration of about 0.005%.
  • Stir the mixture to ensure that the bleach is completely diluted in the bath water.
  • Have patients soak in the chlorinated water for 5 to 10 minutes.
  • Thoroughly rinse skin clear with lukewarm, fresh water at the end of the bleach bath to prevent dryness and irritation.
  • As soon as the bath is over, pat the patient dry. Do not rub dry, as this is the same as scratching.
  • Immediately apply any prescribed medications/emollients.
  • Repeat bleach baths 2–3 times a week or as prescribed by the physician.
The following restrictions apply:    
  • Do not use undiluted bleach directly on the skin. Even diluted bleach baths can potentially cause dryness and/or irritation.
  • Do not use bleach baths if there are many breaks or open areas in the skin (for fear of intense stinging and burning).
  • Do not use bleach baths in patients with a known contact allergy to chlorine.

Placebology for Warts

Warts seem to lend themselves to wackadoo mind-body interventions and other folk medicine approaches. They're a slow-growing viral infection that usually last until your immune system decides to fight them off. Thus anything that irritates the wart or activates your immune response seems to help. Here are some nifty but not-well-researched ideas for warts, short of freezing them off. Now, I do love my liquid nitrogen; it's fun to use and you can do some cool office tricks with it. But consider trying these first:

  • Trace an outline of the affected body part on paper very night, and let your child draw a big 'ol X over the wart area
  • Rub the wart with a cut potato, and bury the potato one foot deep at the stroke of sunset, or some such complicated ritual. Tom Sawyer used a "spunk-water stump" in the middle of the woods.
  • Go to a "witch doctor" and have a wart-begone spell done (this worked for my mom growing up in France), or just come up with your own incantation and do it every night.
  • Daily hot water soaks have had some claims of efficacy
  • Apply apple cider vinegar on a piece of cotton gauze under a bandaid each night
  • Or apply dandelion milk nightly, or banana peel, or garlic juice ... I could keep going here folks, and probably will. Feel free to add your own wart remedies in the comments. This page has quite a collection as well.
  • Finally, there's the infamous DUCT TAPE therapy. This one has a published study to support it, where 85% of warts resolved with duct tape, compared to 60% with freezing. Apply a piece of duct tape the size of the wart directly to the wart and remove it 6 days later. If it falls off, reapply a new piece. At 6 days, file the wart with an emery board or pumice stone after soaking it in water. Leave the wart uncovered to air overnight. Repeat the 6-day cycle in the morning, for up to 2 months total.
In general, if you're treating the warts topically (duct tape, salicylic acid paints and plasters, etc), you want to keep them filed (emery board) or shaved/clipped down to the fresh wart skin, so get rid of the dead skin regularly. Soaking first can help, so why not try that "hot water therapy" while you're at it. Have fun!

Ink Test for Scabies

Here's a simple test that you or your doctor can do when you're asking the "is it scabies" question. First, look carefully for fresh itchy bumps or thin grayish squiggly lines (burrows) in the skin, especially at hands, inner wrists, fingerwebs, elbows, armpits, ankles, feet, diaper area, belt-line, and abdomen. Infants and young children can get scabies on the face, scalp, and neck, unlike older folks. Magnifying glass and bright light can help.

Take a dark washable wide-tip marker, and rub around the suspicious bumps or burrows. Then take an alcohol wipe or alcohol-soaked gauze and wipe away the ink. If there's a scabies burrow under the skin, the ink often remains, showing you a dark irregular line. Occasionally a tiny dark dot is visible at the end of the burrow - that's the mite.

At the doctor's office, we might use mineral oil and a scalpel to scrape the burrow and a fresh bump or two onto a microscope slide, to look for the mite, or its eggs and feces. But the ink test can be done at home, if you're curious that way. In children recently adopted from institutional care, we do have a pretty low theshold to treat for scabies for intensely itchy skin rashes.