Only seven, but she has body odour
Q MY SEVEN-year-old granddaughter has a body odour problem. Her mother has given her Fresh Kidz deodorant but it doesn’t seem to mask it. I would hate her to get a tag in class of a smelly child. Her T-shirt is changed daily, she washes under her arms with soap each morning and showers three times a week. Is there anything you can suggest? A BODY odour is not unheard of in children, but it certainly warrants a little bit of thought about the potential causes.
The sweat glands within the armpits produce fluids that react with the native bacteria on our skin and produce the familiar odour of sweat.
These glands are activated with puberty along with all the other physical features of puberty, so we usually expect body odour to become apparent at this stage.
The first question therefore to ask about a child with body odour is whether puberty has started early – this is called precocious puberty. This would be apparent with other obvious features. If a child is exhibiting precocious puberty, a specialist referral is warranted to an endocrinologist for management.
It is possible that a child can have body odour without precocious puberty. Some children may simply have more sweat glands than others, so even prior to puberty would produce more odour without the puberty activation of the glands.
There is a rare condition worth considering in a child with unusually strong body odour. Trimethylaminuria is a condition where the body is missing a certain enzyme and creates a very strong smell in the sweat. This is sometimes called fish-odour syndrome. It would usually become apparent at weaning but can in fact present at any age.
Because of the specific enzyme deficiency, it would be more apparent after eating certain foods including eggs, beans, cabbages and seafood which a child may only start eating once their tastebuds mature.
Of course washing and hygiene affect the smell of the body but clothes can too – certain synthetic materials will react more with bodily secretions and create a smell. It is worth considering using all cotton clothing that allows the skin to keep fresh. Adult deodorants would not be recommended for children. An aluminium-based prescription antiperspirant can be used which reduces sweating – this can be bought over the counter but for a child I would recommend consulting a GP first as it can irritate the skin. QI HAVE just been told the cause of my back pain, according to an MRI scan, is an ‘anterior wedging of T5’ and that I am suffering something called insufficiency fracture. I am now being treated for calcium deficiency. My doctor tells me there is nothing else that can be done. Is she right? A AN INSUFFICIENCY fracture is a very specific type of break of the bone which by definition happens only to weakened bones. The bone breaks in response to very normal stresses and strains that a normal bone should be able to tolerate; so it could happen for example from the impact of normal walking. The spinal bones – the vertebrae – are a common site for this to occur. Treatment would normally be classed as conservative – this means allowing the bones time to heal themselves with no surgery or brace.
When someone suffers an insufficiency fracture, it is vital to ask why the bone is abnormal and treat this condition. Scans including a DEXA bone scan are used to find the answers, so active prevention of further fractures can be undertaken.
Insufficiency fractures are most commonly seen in those with osteoporosis, a condition where bones lose their density and become weak and fragile. It is most often, but not exclusively, seen in post-menopausal women.
Active treatment of osteoporosis is a common undertaking for a GP and is far removed from ‘nothing to be done’.
Osteoporosis is treated with specific medicines such as alendronate or sometimes HRT depending on the individual.
Paradoxically, some osteoporosis treatments may not be recommended for someone who has had an insufficiency fracture, but there should be other options.
If necessary, a specialist referral to a rheumatologist is needed to explore this. Along with treatment, avoidance of further weakening is needed. This is achieved with calcium and Vitamin D supplementation, and reduction in alcohol and smoking.
Weight-bearing exercise is vital to reduce osteoporosis but, for someone who has had an insufficiency fracture, this would need to be under physiotherapist guidance. Exercise would involve strength training of certain muscle groups, without placing stress on the weak bones.