You may be surprised what your hands say about you to a doctor. I’m not talking about hand gestures, but good ole’ fashion looks. In a matter of 3 seconds, a doctor will make judgments about your hygiene habits, nutritional status, and overall health. Here’s a few of the things I’m looking for when I look at a kid’s hands:

Hygiene

Generally speaking, people try to “clean up” and be presentable when they go to the doctor. Clean hands and nails tell me that the child (and/or the parents) have reasonable hygiene habits. If the kid’s hands and nails are filthy with grime all around the nail beds, it’s easy to jump to the conclusion that hygiene and other related care items (e.g., daily baths and twice daily teeth brushing) are likely not happening. Now someone will read this and be offended saying, “my kid was just playing in the mud right before visit,” and I understand that sometimes that is the case. Usually there will be other indicators to help further the case of poor hygiene (e.g., plaque over the teeth, messy hair, dirty/stained clothes, body odor, etc.). So wash your kids’ hands before they come to the doctor.

Nails

How nails look give great insight into a person’s health. The nails are often the most telling part to the hand exam. When something is abnormal about the nails it often means there is a nutritional or mineral deficiency.

1. Jagged/dirty nails say, “I don’t take detailed care of myself” (or rather the parent isn’t taking detailed care of child).
2. Discolored or yellow nails can be a sign of infection (like fungus). They can also be from staining (e.g., chronic polish wearing). B12 deficiencies can cause brown-grey discolored nails.
3. White spots on the nails (called leukonychia) are usually caused by injury to the nail (or rather the matrix or base of the nail). It just takes a while for the white spots to show up so people don’t connect the two. White spots can also be causes by an allergic reaction (like to a new polish) or temporary illness.
4. Ridges:
   1. Horizontal ridges can be caused by fever, infection, inflammation (lots of chronic diseases cause inflammation), hormonal issues (seen with menstrual issues), or protein deficiency.
   2. Longitudinal ridges can be caused by vitamin A or C deficiencies, calcium deficiencies, anemia (including iron deficiency), circulation issues, or thyroid issues.
   3. Super short nails (with no white growth or free edge showing) that are a bit jagged are usually a sign of a kid that has been biting or picking at his/her nails.
5. Spoon shaped nails (called koilonychias) can also be a sign of a nutrition problem (usually iron deficiency). Spooned nails can also happen with diabetes, protein deficiencies, some system problems (like lupus) and exposure to chemicals. Of note, some kids have nails that are naturally spoon shaped. Your pediatrician can help you decide if it’s within the normal range.

Cuticles

1. Hangnails can be a sign of vitamin C, folic acid, or protein deficiencies
2. Darkened cuticles can be a sign of melanoma
3. Scaling can by a biotin deficiency

Skin

If the skin is scaling, peeling, or pale it may be a sign of nutritional deficiencies (including iron, zinc, vitamin B12, vitamin B6, and folate deficiencies). Little red spots may be a sign of petechiae and red-brown papules may be from follicular hyperkeratosis, both of which can again be associated with nutritional deficiencies. Some kids just have really dry hands and need more lotion/moisturizers. Some people will have full blown eczema or psoriasis on skin of the hands.

Muscles

If the muscles in the hands are starting to waste away (so that your kid’s hands look more like those of an old lady), you’re in trouble. Wasting of the muscles happens when kids are starving or have serious underlying medical conditions (like cancers).

What will the pediatrician do if she sees a problem?

Do not be surprised if your pediatrician suggests doing a further workup when she finds a problem with your child’s hands. As you can see, many of the problems are caused by nutritional problems. For this reason, your pediatrician will likely suggest blood work be done to test for specific vitamin or metabolic problems.

What can I do now?

Take a look at your own children’s hands. Do they need a little TLC? Maybe we need to ensure your child is getting enough vitamin D and calcium? Maybe we need to start multivitamins for your children. If you have any questions or really concerning signs, you may want to take your child in to see the pediatrician. Good luck!