Q&A with Dr. Jay

Question: My 7 year old son stepped on a wooden board with a rusty nail in it. The nail went through his shoe and into the heel of his foot. It bled quite a bit but has stopped now. It is slightly painful but he can walk on it. What are my main concerns?

Dr. Jay: Your first concern should be to look for any signs of infection. Redness around the puncture site is usually the first sign of infection. Then, you may see drainage from the site. The last part of the infection is red streaks extending from the site and into other parts of the body. If any of these things are seen, seek immediate medical attention. The other concern is your son’s tetanus status. If he is up to date, he should have received his last tetanus shot at age 4 or 5 and that is good for 7 years. The danger has nothing to do with the fact that it was a rusty nail but that it was a deep puncture wound. Tetanus can be contracted by a clean or dirty or rusty item. If you are not sure about your son’s tetanus status, call your pediatrician and ask them to check. If they are unavailable and it is possible that your child is not up to date, you should receive the booster for their safety.

Question: My 4 year old daughter has an area on her scalp about the size of a nickel that is bald. What are some possibilities of the cause?

Dr. Jay: One cause may be a fungal infection of the scalp. You will usually see dots in the area where the hair shafts were. This will need oral medication for it to resolve. If you see different lengths of hair in that area and some areas that are thinner than other areas, your daughter may be pulling her hair out. There may be a psychological issue that will need to be addressed. If you see a shiny, smooth area where there is no hair or roots at all, it may be a finding called alopecia areata and there may be no reason this is occurring. It would be advisable to seek a dermatologist for this problem.

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