You see a three year old in clinic with the lesion shown. Should they be referred? What can be done?
Often, even for (medically) benign conditions, families are seeking advice on how to help a child think about differences in their appearance. Check out this article from the Washington Post Parenting Section. Author Wendy Wisner gives some great advise about talking to young kids about physical differences such as birthmarks.
Remember, preschool and early elementary school aged children think in concrete terms: “I am 4”, “I have freckles”, “Bobby is loud”, “Gia lives in Boston”. They become very aware of details relating to appearance and it is helpful to give them the language to understand and talk about differences.
Kids need to know that differences are normal. This is a nice starting point for parents to discuss how a child feels when someone notices something different about their physical appearance. Parents can have kids practice matter-of-fact ways to respond when confronted about their appearance. “That’s my eczema, it is dry skin” and even “I don’t want to talk about it, can we play something else”.
Most parents instinct is to shelter their child from these sorts of conversations to avoid hurt feelings. In the long run, it is better to help a child learn to have these conversations so they begin to build a sense of resilience that sticks around, even when parents are not there to swoop in and save the day.