I had my 10 mo dropped off today as usual, nothing was out of the ordinary. When I changed his first diaper, right above the diaper line on his abdomen to the right is what looks to me like a cigarette burn. Its very dry/scabby and perfectly round and red all around it. I've never seen any thing like this on him before and it DEFINITELY wasn't there on friday. I know that I have to report suspicions of child abuse or neglect to CPS but wasn't sure how to approach it. I never would have thought that this family would do something like this and am still not sure that's what it is for sure. How do you guys judge this? Have any of you had experience with this? Should I ask the mom about it? I was thinking about asking her about it and telling her I needed a drs note to see what it is because of the suspicion but I don't know how to approach it. Any advice?!

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I would photograph the injury. Document it and put it in the child's folder.

I would NOT call CPS unless I felt there were other signs leading me to think there is possible abuse/neglect.

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I am going to say do not call WHY because it is Monday and it was not there Friday. If it was a burn it would not be dry and scabby.... I would take a picture, document it and call mom and ask her if she saw it and what is it.

a burn would still be red raw and oozy

If it looked like a burn I would call in a heart beat even if it is the first time

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IMHO, unless you feel that it could be child abuse, call the mom and ask her about it.

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I don't THINK that it is child abuse, but it just looks so strange and suspicious. I am going to ask her about it at pick up and see what she says. Do you guys think it is ridiculous to have her get it checked out by a dr for my records?

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could be eczema or the start of ring worm. can you post a pic of it?

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Eczema I am pretty familiar with, we have another boy here that has it and it never gets so red like that AROUND it. It looks like whatever it is is infected or REALLY irritated. I snapped a pic of it on my cell but its not very clear or detailed. I will try again when he wakes up from nap. Ring worm I haven't seen in years so I don't know if it gets red like that around it but it seems too small for ringworm..

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Unless it was infected, I wouldn't require a doctor's visit.

I would however, document what you see and know. Have mom sign and date something stating you asked her about it and what her reply was. If mom signs and dates the documentation it proves you DID bring it to her attention and were concerned. I think that covers your bases

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I would ask mom about it. I have dry skin and every so often I also get round, dry/scabby circles that are red around the outside on my skin allthough they are usually on my arms or legs.

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Sounds like a dead wringer for ringworm which is extremely contagious.

I'd have mom or dad get him in to see his doc asap.

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Or MRSA? I had a girl with it once....dry,.,red, scabby, circular.

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Could be, not worth taking the chance either way!

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could be. I had it . Exactly what it looked like.

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I was actually told recently (2 weeks ago) in a child abuse seminar that we are NOT to photograph it and we ARE to report it. Photographs can, apparently, get you into trouble.
I am in the south.

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At the seminar, they said to call CPS and write down the date, time you called, and who you spoke to about it. Even if you want to remain anonymous give them a fake name (Suzy Q) so if child abuse is occurring and it appears as though you never reported anything, you won't be in trouble. You can quickly call to their attention the date, time, and alias name you called in under.
Otherwise, you can be in a great amount of trouble if those parents are convicted of child abuse in the future because you never reported anything yet you had them for large quantities of time throughout the week.

I would tell Mom to take DCC to the Doctor.

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Ringworm would be my guess.

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I would call and ask the mom. But, I don't think that I would suspect child abuse or a cigarette burn. Even if it was a cigarette burn, I doubt that's abuse, more like a stupid person changing his diaper with a cigarette in his or her mouth.

I would suspect an infection of some sort, or a spider bite. Heaven forbid a brown recluse bite, or MSRA, but something other than a cigarette burn. So, i'd document it, and then call the Mom and ask her.

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This is the mark.

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That doesn't look like a cigarette burn or ringworm to me. I would definitely have mom take her to the doctor before she returns to daycare though since you can't possibly know whether it's contagious or not.

There is a possibility it could be MRSA...doctor's note for sure

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Looks to be more of an insect bite?

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You were told to report injuries even if you didnt think it was abuse???

I dont understand that at all

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After seeing the picture I still think ringworm.

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Definitely doesn't look like an insect bite. Its a really strange mark...

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Psoriasis? He doesn't have it anywhere else? Check behind his ears.. and hairline - that seems to be a spot most people have that.

I agree about pointing it out and having them get it checked at the Dr's.

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I would just call mom and ask her

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Sometimes the simplest answer is the RIGHT one.

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I would call mom or at least speak to her about it at pick up time. I usually write down things like this for my records. Something simple like, "Round red spot on abdomen above diaper line. Spoke with mom about it, her response was ______. Dr. note requested before returning." I would much rather overact and send them to the dr with nothing wrong, than assume it is fine and find out it was contagious and I didn't do anything. The dr would also be required to report it if it possibly was due to abuse.

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I would ask mom about it when she picks up. Even if it is a cigarette burn maybe there is an explanation. Like he walked into the ashtray or something? Still sucky parenting but not necessarily intentional.

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Whatever it is, it looks like it is getting infected. I would have Mom pick up and have it looked at. Just in case.

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Definitely doesn't look like a cigarette burn mark. When I worked in an advocacy center that dealt with abused children they looked very "raw" when new in the middle and then there's a circular scab when it begins to slightly heal. There was a football player that adopted a toddler and infant twins. His wife burned the older child all over (including the genitals). I still feel traumatized.

http://www.childabuseconsulting.com/...use-burns.html
The image on the far right is a cigarette burn.

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No. If you suspect abuse AT ALL you are to report them.

People tend to think that CPS will swoop in and take any and all child that they get a call about and that simply isn't the case at all. My own son (adopted) had CPS involved in his home life many times prior to us getting him (through a private attorney, NOT CPS) and CPS never took him. His situation was severe, too (every kind of neglect and abuse except for sexual). I wish more people had called CPS for his sake and that of his older siblings.

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Sounds like ring worm to me. Have you googled pics of ring worm? They can appear anywhere on the body and will often spread.

They are airborn...it is a fungus. Extremely contagious!!

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That doesn't look like ringworm to me... It looks more like an abscess and yes it does look infected.... So yes, I'd ask mom and have her get a doc note to be sure it's not Mrsa

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Ijust saw the pic...it's hard to say. It could be a spider bite too.

I would point it out to mom and recommend a drs visit just to be sure.

I would not jump to assume there is abuse UNLESS you have suspected abuse in the past.

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whatever it it's, it needs looked at. i am not one to say that lightly, either. mrsa, ringworm, spider bite...they can all look similar and can all look like that. doctor, asap.

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Gooooood point... Spider bite.... Had that exact identical looking wound after I got bit on e leg many years ago... And OT my cat had the same thing... When a spider bites, basically that circle of area around where the bite happens dies... And sinks in.....

But that has to be looked at by a doc quickly.... Those things have serious complications if not treated!!!

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The pic looks similar to the MRSA one of my dcgs had.

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I second this. I exclude for any kind of rash the second I see it. I do not allow for the child to come back until I have a doctors note of diagnosis. If its something contagious, then I won't let them come back until the rash is completely gone from open areas of the body that is exposed to others. The rash must have worked its corse ans child must no longer be contagious.

As BC taught me, we don't care what is causing it, we just need to exclude for the symptoms that are present.

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After I talked to her she told me she noticed it last night and wasn't sure what it was. She forgot to tell me. She also asked me if I thought she should take him to the dr. She ended up picking him up a bit early and took him in. I'll update everyone when she tells me what they say. I also documented it and took a picture for his file.

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"Skin infection". I'm sure I'll get better details tomorrow. They started him on antibiotics and said he can come back as long as its covered and shouldn't be an issue.

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Is it too late for you to get a written diagnosis from the doctors ?

When a child goes to the doctor here I always require a written note of diagnosis with treatment plan. It's up to me to decide if I can still provide safe care for all of the children.

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That definitely looks like MRSA. You need to ask for a doctor's note. I had to deal with MRSA before with DCk. It is so contagious you do not want to handle improperly. DCM may be saying skin infection bc she knows you should not care for child with that boil.

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MEDICAL BACKGROUND HERE!!

Maybe Nanyde can comment, but sister that does look like MRSA! RUN

MRSA IS a skin infection! I would not allow him back into care until it's gone!

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It does need to also stay covered, like with gauze. Poor baby, I'd be worried about HOW he got it .....

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Dr apparently just said skin infection. A form of staph but NOT mrsa which is why he is on an antibiotic. She also got a drs note saying he could return so I don't see a reason to say other wise. With the location it'll be covered all day and won't touch any other surfaces.

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How did they get the results back that fast? Last time I had a mrsa scare it took 3 days to get the culture back.

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It does take days for the results. Staph alone is scary. Please wear gloves when handling this child. You are asking for an outbreak. Child would be put on meds if they had MRSA too.

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If the doctor did not take a test then how does he/she know exactly what it is and if the child is contagious?

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I'm not sure. After looking online I don't think it looks like mrsa and I guess the dr didn't think so either. I would say it looked more like impetigo which is probably what he was thinking. I don't know if they took a culture or not but I have no reason to doubt her or her dr (it's the same pediatrician as my daughter and the same one I saw from 11-17). There was no boil or anything like that. Just the dry patch/scab type thing that popped up.

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Remember the doctor works for them not you. Any outbreak is easily explained by lack of good handwasing. It's on you now if it is contagious. Do you want to take that risk before the culture comes back...assuming he DID one. Staph is no joke.

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I would just keep it covered, keep his nails clean, and perhaps ask the parents to stick him in a onsie.

I wouldn't refuse to keep him if they had a doctor's note. I'd just take extra precautions.

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That's a great idea... when you know they're going to the Dr ahead of time.

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I have not read anyone else's responses but I did have a child (toddler) who had sensitivities to diapers at times & she got round red sores that could have been mistaken for cigarette burns from where the diaper rubbed her on her belly. The parents did not smoke. While I think it is good to be concerned I would not jump to conclusions.

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I have a policy that lists symptoms for exclusion and any undiagnosed rash is on that list. I also say that I need a Drs note with a diagnosis, doctors instructions AND that the child is NOT contagious (even to newborns) then right after that I clearly say that I will take the note into consideration but that ultimately I make the final decision. It's always good to be prepared before a situation arises.

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i have a rule that kids have to be excluded for 24 hours after starting antibiotics, to give the medicine time to take effect, for the child to feel better, and for the parents to monitor for any adverse reactions. this at least buys me some extra time that i don't have to argue with the parents about the kid needing to stay home. after all, the 24 hours symptom free rule still applies as well, and the two not mutually exclusive, if that makes sense. the child must met both criteria.

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By covered it's best for it to be covered with a gauze patch.... NOT just clothing!

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I know. But, a onsie would be an extra later of covered.

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I had a kid who had a mark like this. I bet you he was bitten by a bug, and because its located by the diaper line, it was rubbing and got infected. the dcb that I was watching was in his excersaucer and outside and a bug got him. By covering it, will help it from getting worse because we all no how clothes rub on a baby. Mom should at home keep it uncovered to help it dry up faster and make sure nothing rubs against it.

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Speaking of bug bites, the complication of scratching those can lead to impetigo.. Which is very common... And is an exclusion for care at my house.... It really doesn't look like Mrsa to me, but I'd have to see that culture first before I was convinced.

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Sounds like you've got it under control OP

While we can all speculate none of us have seen the wound first hand and even if we had none of us are doctors in a position to professionally diagnose anything.

You really need to trust your gut instinct on how to proceed, I'm hoping it's something easily remedied by the antibiotics so there is no cause for future concern. I hope mom thanked you for you diligence!

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