Head to Toes, Part 1: The Problematic Head

The head is the first thing to emerge in the world; assuming the baby is not breech and comes out butt-first trying to make a statement. Throughout the childhood years, the head is often a source of many concerns.

One of the first concerns that a new parent has is head size and shape. Squeezing a head through the birth canal can cause some interesting shapes, sort of like a cone-head. Baby heads often become flat on one side, if they develop a preference for position. Heads can be small; and they can be huge. Assuming that the child is not hydrocephalic, big heads are usually genetic. I once had a father ask me why his child had such a big head, and when I looked at the Dad, he had a head like one of those Macy's balloons. I always tell parents that big brains require big heads, and that their child will more likely become a surgeon or attorney (although some attorneys have pin-heads).

I love baby hair, but parents are absolutely shocked when they see their little daughter with a hairy back or butt. Babies also have very hairy ears, making a routine ear exam quite challenging. Thick beautiful, curly baby hair is a symbol of pride. Bald babies are also pretty cute, even though they look a bit like Uncle Fester. Bald little girls often get pierced earrings or wear some taped-on hair ribbons so as to not be confused with boys. Parents are also concerned when a bald spot emerges on the back of their heads, obviously worn away by head movements. Now looking like a monk, this hair will grow back in time.

Every parent is worried about the fontanelles -- the soft spots. They are afraid to touch it. When my youngest brother was born, I was sternly warned as an 8 year old NOT to touch his soft spot for fear of causing irreversible brain damage. Of course, I did poke him a few times just to see if it would affect his IQ, but alas, he turned out relatively normal (for my family, at least).

Head injuries are another common problem that I see in my clinic. Kids in motion lead with their heads, so this is usually the first thing that meets that pavement. Sometime, they just get a huge goose-egg; sometimes they can a laceration. The scalp has a very rich blood supply, so it does not take much of a hole to cause significant bleeding. New parents panic at the site of blood. Rather than simply put pressure on the bleeding site until it stops, they tend to call 911 or rush them in to my clinic. I saw a child last week completely covered in blood. It took me a good ten minutes to find the tiny hole that caused it. He didn't even need stitches.

Each week, I suture up three or four little heads. Sometimes, I will use surgical staples, but most times, I just use the standard nylon sutures. I even repaired a scalp laceration one time by tying and braiding the hair across the wound. Kids (and parents) freak out about stitches, so if a child does not want stitches, I tell them that I will only use sutures (they are the same thing).

I also tell them, that if it hurts, I will stop, but most of the time, sutures will tickle. They have to promise me they will not laugh. By preparing a child in advance that something may tickle, this is what they will expect. I can count on one hand the number of times that I had to restrain a child in a papoose board (probably not a politically-correct name to use). Emergency Rooms tend to always strap down kids, and it scares the crap out of them (literally, sometimes).

Most children will simply sit still and cooperate if you quietly work with them and tell them exactly what you are doing and why. When I inject the lidocaine to numb the area, I simply tell them I am cleaning the wound. Before they know it, I have a half a dozen sutures in place, they got their sugar-free lollipop, and they are on their way home. Suture removal day is fun, since I always give the sutures back to the kids to put under their pillow for the Stitch Fairy.

Heads also can get head lice (also called the California Scalp Cricket in my office). There is nothing more harmless and more devastating than hearing that your child has head lice. Only one of my five kids (my only daughter) came home with head lice. Her long braided hair probably acted like she was trolling for them. Head lice treatment is relatively easy anymore using an insecticide made from the chrysanthemum plant. This stuff will kill lice and the eggs (nits), but you still have to hand-remove the dead nits. This is where the term nit-picking originated. The best way is to simply pull them out, one at a time. Some people have used mayonnaise, Vaseline, and other egg-removal products, but in the end, parents are always nit-picking. Most schools have a firm no-nit policy before the kids can come back. Regardless of urban legends, head lice do not fly, jump, or come from dogs. Head lice are human parasites. You can blame the dog for random flatus, but not head lice.

Related Topics: Parenting, Got Lice?

Technorati Tags: breechbirth, headinjurychild, fontanelles, headlice,