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On Call: Puffy Peepers

Q. Even after a good night's sleep, my child gets dark, sometimes puffy circles under her eyes. Is that normal?

A. I see this frequently in my practice, and it's usually nothing to be concerned about. The skin under the eyes is quite thin, especially in children. When there's increased blood flow in this area  -- such as when you have allergies  -- it can make the under-eye area look dark. Doctors call these circles "allergic shiners" for this reason, but they can also be seen in people who have enlarged adenoids or have had years of sun exposure. And they can run in families.

In adults, dark circles can be a sign of fatigue or illness (especially anemia), but this is rarely the case for kids. So if your daughter seems unusually tired or listless, or if she has any symptoms of allergies (nasal congestion, red or tearing eyes, sneezing, eczema or other rashes) or of enlarged adenoids (a nasal-sounding voice, breathing with her mouth open, snoring), call the doctor. Otherwise, she should be fine.