Red Bump Causing Little One Pain? Don't Blame the Itsy Bitsy Spider
By Sam Smith, MD, Surgeon in Chief, Arkansas Children's Hospital
In the Emergency Department at Arkansas Children's Hospital, we see this scene replay over and over: A mom comes to us concerned about a spider bite on her infant's groin or upper leg. She first noticed it a few hours earlier during a diaper change. It's red, raised and hot. She checks it again in a couple of hours and finds it's nearly doubled in size and looks even angrier. Now it's time to load baby up and head to the ER.
It's a good thing she made the decision to go to the hospital because the spot will need to be opened and drained. But there's no reason to blame the innocent spider; her baby most likely has a soft tissue Staphylococcus aureus – or staph – infection.
We see staph infections year-round at ACH in every age we treat. From the baby described above to the burly 18-year-old athlete, no one wants the pain and aggravation that comes with this type of infection, but they can be tricky to avoid.
One thing we know is that germs love any breakdown of the skin and any warm wet environment. They hate dry. Diapers may be good at wicking, but organisms can be trapped in the lining of the diaper, and this is how little ones sometimes end up with staph. This is one reason why frequent diaper changes are important.
Football players may be exposed to the infection by wearing sweaty uniforms that rub against their skin. Anyone in wet clothes should change out of them as soon as possible to prevent the chaffing that can introduce staph to an open wound.
If you notice a bump, sore, or abrasion be cautious about using too much antibiotic ointment on it. Use regular soap and water instead and dry the area carefully without abrading any of the tissue around it. Too much ointment can allow skin breakdown and exacerbate the infection.
What are the signs of an abscess like staph? Most parents notice a hot, red swollen lump, sometimes with a whitish tip almost like a pimple, that is extremely tender to the touch and somewhat soft, like it's full of infected liquid. The pain will indicate that the child needs to be seen by a medical professional who can help open the abscess and drain the infection.
Most of the time, staph infections on the skin can he handled in the outpatient setting like an emergency room. An abscess that is large or in sensitive areas like the bottom or groin will likely require sedation before it can be opened and drained. Before you head to an emergency medical care provider to seek treatment of this kind of infection, your child should refrain from consuming food or liquids. Eating or drinking delays treatment since sedation requires an empty stomach. This decreases the risk of stomach contents getting into the windpipe or lungs. Failure to stop eating and or drinking is one of the most frequent reasons for delay in treatment and can convert a two- or three-hour trip to the emergency department to a 10-hour marathon.
If the procedure is done in the emergency department, the child will usually be able to go home afterwards. The patients who require an overnight stay in the hospital include those who have systemic signs of infection – like a fever – or high-risk individuals like newborns or diabetics.
It's possible that your child will need antibiotics as he or she recovers from a staph infection, and you should always follow your physician's directions for those.
The best thing you can do to prevent staph infections in your home and elsewhere is to ensure your family maintains careful hygiene habits. Wash hands frequently with soapy water for at least 30 seconds, especially after using the bathroom. Use clean, dry towels and never linger in sweaty wet clothes, including uniforms or swim suits. Clean and cover all open wounds, abrasions or sores.
Families shouldn't worry too much about staph in most public places because it's already in our bodies anyway. Your child without damaged skin isn't any more likely to contract a staph infection in his classroom or locker room than in any other location.
Most of the time children recover quickly from a basic staph infection once they receive medical treatment. But that doesn't make the scenario any less painful or scary, even for mom and dad.
Just remember: Next time you notice a hot, red bump, it's OK to blame staph. The itsy bitsy spider doesn't deserve all the notoriety!
Sam Smith, MD, is surgeon in chief at Arkansas Children's Hospital and a professor of Surgery at the University of Arkansas for Medical Sciences. He writes a column each week covering a variety of kids' medical concerns. If you have a topic you'd like him to consider addressing, email firstname.lastname@example.org.