Lichen Striatus, My Daughter’s Story

Lichen striatus is a benign and self limited rash that occurs in children anywhere from 5 to 15 years in 50 % of cases. However, my daughter was 2 years old when she suddenly had this rash appear on the back of her right leg. Females tend to be more affected by this than males. There is no known cause for this rash except possibly some environmental and genetic factors.  Below are more details about this rash as per :

What does lichen striatus look like? Lichen striatus starts as small pink, red or flesh colored spots that over the course of one or two weeks join together to form a dull red slightly scaly linear band. The band is usually 2 mm to 2 cm in width and may be a few centimeters in length or may extend the entire length of the limb. Sometimes there are two parallel bands. Lesions occur most commonly on one arm or leg but can affect the neck or trunk. Sometimes a band may extend from the leg onto the buttock or abdomen. Usually there are no symptoms but some patients may complain of slight or intense itching. Occasionally nails may be affected, sometimes without any skin lesions. They become thick, ridged, split and may rarely fall off altogether.

How is lichen striatus diagnosed? Lichen striatus is diagnosed by its typical clinical appearance. Findings on histopathology of a skin biopsy may also be helpful.

What treatments are available for lichen striatus? There is no effective treatment for lichen striatus and in most cases none is necessary. It usually resolves within 6 months but may leave temporary pale or dark marks (hypopigmentation or hyperpigmentation).What does lichen striatus look like? Emollients may be used to help treat dryness or itching, if present. Topical steroids or pimecrolimus cream may clear the lesions although they may take some weeks to be effective.

My daughter’s rash started as a group of palpable pink spots on the back of her thigh. From that patchy rash extended a linear strand that led to a similarly patchy red rash all over her posterior calf. The bigger patches were slightly itchy at times. Her rash lasted about a month and did not leave any hypopigmented areas. Below are 2 pictures of my daughter’s rash on the back of her right leg.

rash rash2

If you have questions or if your child has a rash, please call your pediatrician’s office.

My Child is Older, Does He/She Really Need a Checkup?

When your child is preschool age it often seems routine to get a checkup.  After the kindergarten checkup many people wonder what the purpose of a checkup really is. KPA and the American Academy of Pediatrics strongly recommend physicals every year through adolescence and into young adult years.

There are no more dynamic times in one’s entire life than the pediatric years when growth, developmental progress, school performance issues, social interactions, athletic readiness, allergies, weight to height relationships, curvature of the spine, digestive issues, nutrition concerns, acne, bullying, abuse, family discords, puberty questions, height predictions to name a few issues, are requiring attention regularly.  Your pediatrician is especially skilled, like no other medical provider, to address these and myriads of other problems that are part of the physical, social, and emotional makeup of the ever changing child.

Things such as need for immunizations at 7th grade are necessary and important but only a small part of the pediatrician’s focus. Camp and sports physicals are items that can be addressed without last minute rushes when you get a regular yearly exam.  New and updated immunizations are frequently available to protect against diseases you don’t want your child to get. Getting these done at work or walk-in clinics removes the continuity of regularly addressing growth and overall health as they relate to the past medical, family, and social history that might be uniquely known to your child’s pediatrician.

All of your KPA pediatricians are board certified and maintain currency as required by the board.  This mean retesting on a regular basis as well as yearly requirements for continuing education.  Your KPA doctors additionally maintain competency in pediatric emergency management.

Your child’s health is important to us and to you. Watching them grow with the confidence that a regular complete exam is helpful for us and ultimately for you and your child.  If it has been over a year since your last checkup take the time to call for an appointment.  Waits are not typically long.


It’s Football Time in Tennessee!

…And unfortunately that means some football players will get concussions.  A concussion is a brain injury.  It can range from mild to severe.  In recent years, the frequency with which concussions occur, and their possible long term effects, have been better studied and much more widely publicized.

Attached is a link to the TSSAA website outlining Tennessee’s concussion education and care policy. It is several pages long, but contains lots of very good information on recognizing concussion symptoms, instructions on what to do once a concussion is suspected,  and return to play information and clearance forms.

Many times, athletes and parents are in concerned about getting the athlete back into competition as soon as possible, but it’s important to be sure a young person is completely recovered before resuming competition!

For more information…

Overuse Injuries

Each year, many children and adolescents suffer sports-related injuries.  While most sports injuries are acute, it is estimated that over half of all injuries are a result of overuse.  An overuse injury is an injury sustained after repeated use.  It occurs as a result of repetitive trauma to a bone, ligament, or tendon without allowing adequate time for healing.  Overuse injuries may be difficult to recognize because the symptoms can be subtle and can occur over a period of time.  Some common examples include Little League elbow, jumper’s knee, swimmer’s shoulder, and tennis elbow.  Young athletes can be at increased risk of developing overuse injuries because they are skeletally immature.  There are several other factors that may lead to these injuries including improper training and faulty mechanics.  Some experts have suggested that sports specialization may also play a role in the development of overuse injuries.

A pre-participation physical may detect injuries or identify risk factors for developing overuse injuries.  Participating in appropriate training and practicing proper mechanics can also help prevent injuries.  It may be beneficial for young athletes to cross train and to play different sports throughout the year in order to avoid placing too much stress on one bone or muscle group.  If a child or adolescent develops pain or discomfort with exercise, he or she should decrease the frequency or duration of exercise and rest.  If symptoms persist, the athlete should consult with his or her pediatrician.


Important News: FluMist Not Recommended for the 2016-2017 Influenza Season

In June 2016, the CDC’s Advisory Committee on Immunization Practices (ACIP) made recommendations that, due to poor effectiveness of the live-attenuated influenza vaccine (LAIV, FluMist), practices should not use that form of the vaccine for the 2016-17 influenza season and should only use the injectable form, which continues to demonstrate effectiveness.  The following link is an article from AAP News. 

All KPA offices will only have the injectable form of the flu vaccine in stock for this flu season. Knox County Schools, in conjunction with the Knox County Health Department, are aware of the current recommendations and are working on “how to best move forward” with their in-school vaccination program.  Stay tuned for updates on the Knox Co. Schools flu vaccination program. KPA is planning on having enough injectable flu vaccine stocked at each of its five offices for our patients! Plan on scheduling your child/children for their flu shots beginning this fall.


A Book Recommendation: Quiet by Susan Cain

Whether you or your child is an introvert, you are married to an introvert or work with an introvert, everyone should read “Quiet: The Power of Introverts in a World That Can’t Stop Talking”. In this book, the author Susan Cain discusses how introverts are undervalued in a culture that celebrates extroverts and also helps introverts change the way they see themselves. I highly recommend this book to any parent who says their child is “shy” and explain to parents that we should celebrate their introversion instead of seeing it as a weakness.

She also has a new book written especially for kids and teens called “Quiet Power: The Secret Strengths of Introverts” and has a free podcast called “Quiet: The Power of Introverts with Susan Cain”.

I don’t have very many books on my shelves at home because I’m an avid user of the library but this is one book that I have purchased for myself. My daughter also read this book during the summer before her senior year of high school and found validation for her introversion. She will enter college this fall with a newfound sense of confidence and self. It is a true must read.

Tick Season/How To Remove A Tick

Summer is tick season. It is important to check your children daily for ticks during this time of year if they play outside in yards and wooded areas. This helpful link discusses the proper method of removal. If you have difficulty removing a tick or have questions, please contact us. Have a wonderful summer!

Childhood Obesity, BMI, and a Healthy Tidbit

Adult and childhood obesity has been a major health concern for decades and continues to be so in 2016. Overall obesity rates in children have remained stable for the past several years, but are still very high. Approximately 17% of children ages 2-19 years are obese. This represents 12.7 million children nationwide and many millions more are overweight but not obese. Obesity is defined as having a BMI (Body Mass Index) of greater than 95th percentile. Overweight is defined as having a BMI of greater than 85th percentile but less than 95th percentile.

Body Mass Index is calculated by dividing one’s weight in kg by one’s height in meters squared. The formula for calculating BMI is: BMI = weight (in kg)/height2 (in meters). The actual BMI number is not a particularly useful concept in children because they are constantly growing and at certain times in their growth cycle, the height velocity and weight velocity are at different rates. A BMI of 24 in an adult might be a good BMI, but in an 8 year-old child would represent obesity. A more appropriate concept for children is BMI percentile, which compares the BMI in a child of a given age and gender with the BMI of the rest of the population of children of the same age and gender. Thus, a BMI of greater than 95th percentile represents a child whose BMI is greater than 95 percent of children of the same age and sex, and indicates obesity.

The causes of obesity are very complex and multifactorial, and include race, ethnicity, genetics, behavior, education, socioeconomic status, and outside influences such as food availability and advertising by the food industry.

Two of the most important known behavioral risk factors for childhood obesity are: 1) The consumption of high calorie, sugar sweetened drinks such as fruit juices, soda pop, and sports drinks, and 2) the decline in physical activity and outdoor play brought about by an increase in “screen time” which includes television, computers, phones, tablets, and video games. Elimination of sugar sweetened drinks from children’s diets, and limiting screen time to no more than two hours per day (and thus encouraging physical activity) have been shown to help prevent obesity in children as well as provide benefit in treating children who are already overweight or obese.

A very useful and informative website regarding obesity in both children and adults can be found by searching CDC Division of Nutrition, Physical activity, and Obesity, or go to

Amber Teething Necklaces Are a Choking Hazard!

Amber necklaces are an extreme strangulation risk for young children. They have become almost common place among children in our practice. I am constantly reminding parents to take them off for fear of their young child choking on one of the beads or strangulating on the necklace itself. There is no proven benefit for the amber working against teething. I have 3 children and I use Tylenol or Motrin for pain relief from teething. Cold teething rings are also beneficial. The remainder of marketed items are, in my opinion, dangerous or ineffective. I found the following informative article in the New York Times. Please read for more information on amber teething necklaces.

Please click here.