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Daily Dose

Warm Weather Rashes Still Lurking

1.15 to read

It has been a rather warm winter throughout the country and because of this I have recently seen a few skin issues that are more commonly seen in the warmer months of the year.

One of these is intertrigo which is a skin condition that is often seen in infants who are chubby and have “no necks”.  Because of this “no neck” phenomena, a baby’s chin and lower jaw may rest right on the chest. When parents are bathing a baby they sometimes don’t realize that you have to lift up the baby’s chin and hyperextend the head to ensure that the skin folds around the neck are getting clean and staying dry. This is also true for skin folds under the arms, or in the inner thigh.

When the skin folds rub together the skin can break down and become red, raw and macerated.  If the moisture and rubbing are persistent the skin may even begin to weep a bit of yellowish fluid.

 Babies are constantly dribbling milk from their mouths onto their chins, and then the fluid runs right down and accumulates beneath the neck. On top of this moisture there is also perspiration, especially with warm weather, which accumulates in the skin folds. That is why intertrigo is more common during hot weather.

 I just saw a baby with terrible intertrigo and I think that her parents were dressing her in multiple layers (a T-shirt, flannel onesie and a blanket) and her neck was so inflamed and wet and weepy. I told her Mom that the first thing we needed to do was to take all of this off of her as she was overdressed and overheated. She just needed to be in a cotton gown as it was about 70 degrees outside. 

The best way to treat intertrigo is to stretch out the neck after bathing and really dry it well. I evened used the blow dryer on warm on my own boy’s necks so that I could make sure the skin folds were dry. If the area is still moist and starting to get inflamed I like to use Dommeboro soaks, which is soothing as well as drying. You can buy this at your drugstore (but it is a bit pricey) or you can make a similar solution by mixing 1 part vinegar to 4 parts water.  Apply this solution to the weepy/inflamed area several times a day. I soak cotton diapers or old t-shirts or burp pads and lay it over the area for awhile. There is another product called Zeasorb that absorbs moisture as well.

It sometimes also helps to use a topical cortisone cream to help with the inflammation. There are several products available OTC, or your doctor may also prescribe a steroid cream.

 Because the top layer of the skin has been damaged it is also prone to getting an infection. If the area is not getting better and appears infected you should see your doctor as the skin may get secondarily infected with bacteria as well as yeast. In these cases I use a topical antibacterial cream or anti-fungal cream. In some cases an oral antibiotic may be necessary. 

The best medicine is always prevention, so don’t over bundle your baby and make sure to get in those “creases” so you don’t end up having to treat intertrigo.

That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Breastfed Babies & Diaper Rash

1:30 to read

I was shopping at Target just the other day and happened to be in the “baby aisle” looking for one of those snack cups with the lids to let little fingers get in and not let the puffs fall out.  I needed it as part of a baby gift basket.  Useful for sure!!

So…while I am browsing, I see a young mother and her mother looking at diaper creams and obviously trying to decide which one to buy. I could’t resist offering help (always worry about being intrusive). When I asked what they were trying to treat the mother said, “ my new baby has this raw and red diaper rash right around his bottom”.  “He is just 12 days old and I change his diaper all of the time….how could he possibly get a diaper rash? What am I doing wrong?”

As we say in Texas, “bless her heart”!!! I asked if she was breast feeding,  and she was,  then I immediately knew what she meant. A breast fed infant will poop ALL OF THE TIME.  Many times you change a new diaper and as soon as the next diaper is put on the baby stools again. There are many times when your infant may poop a bit of stool during sleep and when you get them up they have a dirty diaper…all normal. No new mother guilt!!

The good news is that a newborn who is stooling a lot is probably getting plenty of breast milk as well…and that means they are gaining weight too!  The flip side is that it is not uncommon for a newborn to get that raw red bottom during the first month or so of breast feeding.  After that time, the stools do slow down a bit and diaper rash is less common.

The best remedy I have found for treating that tender new bottom is a combination of a diaper cream that contains zinc (Destin, Dr. Smith’s, or Boudreaux’s Butt Paste) and a bit of a liquid antacid (Mylanta, Maalox, Gaviscon). I put  a blob of diaper cream in my palm and then pour a bit of the antacid into it and mix….you can’t use too much of the liquid or it will run off.  Then I take that combo and coat the baby’s bottom. You can’t over do it. Use it with each diaper change.   It seems to do the trick and is easy. Several years ago I told a mother about the concoction (she had 4 children and was very sleep deprived) and I  just said use some antacid if you have some. She called later in the day and said she had tried to crush up the tablets and mix it with diaper cream and it wasn’t working.  I have since learned to be a bit more specific about a LIQUID antacid.  

 

 

 

 

 

Daily Dose

How to Treat Poison Ivy

1.15 to read

With the long weekend here, many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your child has come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

Daily Dose

Summer Skin Infections

1:30 to read

I have been seeing a lot of skin infections and many of these are due to community acquired methicillin resistant staph areus (caMRSA). The typical patient may be a teen involved in sports, but I also see this infection in young children in day care, or summer camp. The typical history is “I think I have a spider bite” and that makes your ears perk up because that is one of the most common complaints with a staph infection, which is typically not due to a bite at all.

The poor spider keeps getting blamed, and how many spiders have you seen lurking around your house waiting to pounce? The caMRSA bacteria is ubiquitous and penetrates small micro abrasions in the skin without any of us every knowing it. The typical caMRSA infection presents with a boil or pustule that grows rapidly and is very tender, red and warm to the touch. The patient will often say that they “thought it was a bite” but the lesion gets angry and red and tender very quickly and typically has a pustular center.

For most of us pediatricians, you can see a lesion and you know that it is staph. It is most common to see these lesions in athletes on exposed skin surfaces such as arms and legs, but lesions are also common on the buttocks of children who are in diapers in day care. The area is angry looking and tender and the teenage boy I saw the other day would not sit on the chair, but laid on the table on his side as he was so uncomfortable. If the lesion is pustular the doctor should obtain a culture to determine which bacteria is causing the infection, but in most cases in my office the culture of these lesions comes back as caMRSA or in the jargon Mersa. When I say Mersa, I often cause widespread panic among my patients, but in most cases to date these infections may still be treated with an oral antibiotic that covers caMRSA, such as clindamycin or trimethoprim-sulfa. Many of the lesions improve dramatically once the site is drained and cultured. I will reiterate that if possible you want your doctor to obtain a culture to identify the bacteria that is causing the infection.

To prevent caMRSA remind your student athlete not to share towels, clothing or other items. Make sure that common areas are disinfected and once again encourage good hand washing. The closure of schools or disinfecting an entire football field or area with turf is not recommended. Lastly, this is a good reminder that you only want to take an antibiotic for a bacterial infection and that overuse of antibiotics leads to resistance. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Spring Weather Brings Spring Rashes

Tonight I saw a little girl who had a hive like (urticarial) rash on her trunk, arms, legs which seemed to migrate from place to place.Sunday evening at our house if often house call night. It is rather fun for my husband (and me) to have young children in our very quiet house. Seems I miss my college boys most on Sundays too, so house calls are therapy for everyone. Tonight I saw a little girl who had a hive like (urticarial) rash on her trunk, arms, legs which seemed to migrate from place to place.

Her parents had noticed the rash the night before and the father had given her some Benadryl before bed. She seemed fine, they didn't think much about it, and then the rash returned later the following day. She was otherwise totally well. No fever, cough, breathing problems etc. and she was racing around pointing out her blotches that seemed to itch. She was otherwise oblivious. This kind of rash is common in early spring as the pollens start to fly. Although parents rack their brains trying to figure out the instigating allergen, we typically never know. These are not hives that are associated with breathing problems and allergic reactions to foods or drugs. The treatment of choice is to keep the child from being overheated (hives will be more prominent and itch more), start an antihistamine like Benadryl, or a non-sedating medication like Claritin or Zyrtec. You can take these on a daily basis for several days and see if the rash goes away. If it does, I recommend staying on the antihistamine for several days even after the hives have resolved, then stop the medication and see if the hives return. These rashes are typically short lived, although on occasion the child may need to stay on antihistamine throughout the spring at which time you should have your child see their doctor. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Treating Stubborn Diaper Rash

1.00 to read

Despite every parent's best efforts, most babies will develop a bothersome diaper rash sometime during their days in diapers. Diaper rashes may be treated with numerous creams and lotions and everyone seems to have their favorites.

I have always been a fan of the zinc-based preparations as I think they coat the skin and provide more protection. I recently had a phone call from a patient who said she had "tried everything" and her son's bottom was still red, raw, bumpy and causing him discomfort. Of course it was over the weekend, so she wanted to see if we could figure this out before the office opened on Monday. If your child develops a diaper rash that does not respond in the first couple of days to the usual "potions" then you might assume they have developed a secondary fungal infection with their diaper rash. Yeast diaper dermatitis is more common than even pediatricians think and doesn't always look like the classic picture of "satellite lesions" on a red base. In a recent article it was estimated that more than 50% of persistent diaper rashes involve yeast, so I think it would make sense to try an over the counter anti-fungal cream in addition to your usual diaper cream. So for that bothersome diaper rash a trial of a zinc-based diaper cream mixed with a little Maalox (yes, the antacid) and a yeast cream may just do the trick and get rid of the red and the yeast. If the rash persists, it's time for a visual diagnosis by your pediatrician. That's your daily dose, we'll chat again tomorrow.

Your Baby

Starting Baby on Solid Foods

Your goal over the next few months is to introduce a wide variety of foods. If your baby doesn't seem to like a particular food, reintroduce it at later meals. It can take quite a few tries before kids warm up to certain foods.Starting baby on solid foods can be an exciting and perplexing time for parents. What foods should I start with? How much? How often?

The American Academy of Pediatrics currently recommends gradually introducing solid foods when a baby is about 6 months old. Your pediatrician, however, may recommend starting as early as 4 months depending on your baby's readiness and nutritional needs. Be sure to check with your pediatrician before starting any solid foods. Is your baby ready? Breast milk or formula is the only food your newborn needs. Within four to six months, however, your baby will begin to develop the coordination to move solid food from the front of the mouth to the back for swallowing. At the same time, your baby's head control will improve and he or she will learn to sit with support — essential skills for eating solid foods. If you're not sure whether your baby is ready, ask yourself these questions: •       Can your baby hold his or her head in a steady, upright position? •       Can your baby sit with support? •       Is your baby interested in what you're eating? If you answer yes to these questions and you have the OK from your baby's doctor or dietitian, you can begin supplementing your baby's liquid diet. What Foods to Start With. Continue feeding your baby breast milk or formula as usual. Then: •       Start with baby cereal. Mix 1 tablespoon (15 milliliters) of a single-grain, iron-fortified baby cereal with 4 to 5 tablespoons (60 to 75 milliliters) of breast milk or formula. Many parents start with rice cereal. Even if the cereal barely thickens the liquid, resist the temptation to serve it from a bottle. Instead, help your baby sit upright and offer the cereal with a small spoon once or twice a day. Once your baby gets the hang of swallowing runny cereal, mix it with less liquid. For variety, you might offer single-grain oatmeal or barley cereals. Your baby may take a little while to "learn" how to eat solids. During these months you'll still be providing the usual feedings of breast milk or formula, so don't be concerned if your baby refuses certain foods at first or doesn't seem interested. It may just take some time. Do not add cereal to your baby's bottle unless your doctor instructs you to do so, as this can cause babies to become overweight and doesn't help the baby learn how to eat solid foods •       Add pureed meat, vegetables and fruits. Once your baby masters cereal, gradually introduce pureed meat, vegetables and fruits. Offer single-ingredient foods at first, and wait three to five days between each new food. If your baby has a reaction to a particular food — such as diarrhea, a rash or vomiting — you'll know the culprit. •       Offer finely chopped finger foods. By ages 8 months to 10 months, most babies can handle small portions of finely chopped finger foods, such as soft fruits, well-cooked pasta, cheese, graham crackers and ground meat. As your baby approaches his or her first birthday, mashed or chopped versions of whatever the rest of the family is eating will become your baby's main fare. Continue to offer breast milk or formula with and between meals. Foods to Avoid for Now. Some foods are generally withheld until later. Do not give eggs, cow's milk, citrus fruits and juices, and honey until after a baby's first birthday. Eggs (especially the whites) may cause an allergic reaction, especially if given too early. Citrus is highly acidic and can cause painful diaper rashes for a baby. Honey may contain certain spores that, while harmless to adults, can cause botulism in babies. Regular cow's milk does not have the nutrition that infants need. Fish and seafood, peanuts and peanut butter, and tree nuts are also considered allergenic for infants, and shouldn't be given until after the child is 2 or 3 years old, depending on whether the child is at higher risk for developing food allergies. A child is at higher risk for food allergies if one or more close family members have allergies or allergy-related conditions, like food allergies, eczema, or asthma. Introducing Juice. Juice can be given after 6 months of age, which is also a good age to introduce your baby to a cup. Buy one with large handles and a lid (a "sippy cup"), and teach your baby how to maneuver and drink from it. You might need to try a few different cups to find one that works for your child. Use water at first to avoid messy clean-ups. Serve only 100% fruit juice, not juice drinks or powdered drink mixes. Do not give juice in a bottle and remember to limit the amount of juice your baby drinks to less than 4 total ounces (120 ml) a day. Too much juice adds extra calories without the nutrition of breast milk or formula. Drinking too much juice can contribute to obesity can cause diarrhea. Infants usually like fruits and sweeter vegetables, such as carrots and sweet potatoes, but don't neglect other vegetables. Your goal over the next few months is to introduce a wide variety of foods. If your baby doesn't seem to like a particular food, reintroduce it at later meals. It can take quite a few tries before kids warm up to certain foods.

Daily Dose

Treating Diaper Rash

1:30 to read

Diaper rash is one of those nasty little problems that most infants and toddlers will experience at some time and that means their parents will have to deal with it. In most cases diaper rash is due to the fact that children in diapers have skin that is in constant contact with urine and stool. Despite frequent diaper changes, and hypoallergenic, fragrance free wipes, diaper rash can happen to any baby. Some children have very sensitive skin and are more prone to diaper rashes.

Diaper rash does not mean that you are not changing diapers enough, or that you need to change brands of diapers or wipes. It most cases it just means that your child's "butt" needs to be more protected. Diaper rash "potions" come in many forms, creams, lotions, ointments. I prefer a diaper cream that is thicker and has zinc oxide as a base as it is more protective and acts as a barrier to the skin. Others may prefer a petrolatum based diaper cream like A&D or even Aquaphor.

Many times you may try several different products and each parent/your-baby duo has their preference. If a diaper rash is persistent despite using a diaper cream, then your your-baby may have developed a secondary yeast (candidal) diaper rash. This often looks like diaper rash with small red bumps that are spreading, "satellite lesions", as they are called. But sometimes, a yeast infection does not look like classic, but may just be a red diaper rash that does not get better. In either case, try an over-the-counter yeast medication in duo with the regular diaper cream. In most cases the over the counter product will clear it up.

If the rash does not improve, it may require a visit to your pediatrician for a prescriptive anti-fungal cream. Yeast diaper dermatitis is quite common and the ultimate cure? Potty Training!

That's your daily dose, we'll chat again soon!

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Daily Dose

How to Treat Poison Ivy

1.15 to read

With the vacation season here many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your childhas come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

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