toddler in diaper
Blog, Infection, Infections, Promotion, What is

My Baby Has A Diaper Rash. What’s That?

 What Is Diaper Rash?

Diaper rash is one of the first things new mothers experience with their newborns that requires intervention from a healthcare professional after going home with their bundle of joy. The old school providers call it nappy rash and the medical terminology is napkin or diaper dermatitis. It is very common for infants and toddlers and accounts for between ten and twenty percent of the complaints that we see in children under 2 years of age. As the name suggests, it occurs around the areas that the diaper covers – the diaper area.

The appearance of diaper rashes varies widely and so does the range of causes. There is also a healthy overlap of how these rashes look and so some expertise is often needed to make the diagnosis. The skin changes could range from mild inflammatory reactions of the skin in the diaper area to extensive erosion of the perianal skin. The rash color may be pink, red or same color as the infant’s skin. In very severe forms, there could be crater-like ulcers exposing a raw area of flesh. Of course, the more severe forms are more of a rarity. More often one would encounter small spots or blotches localized to a small area.  Affected babies are well-appearing and not ill-looking, especially in mild cases. Because it is usually a mild condition, treatment can be done at home, but it remains a concern for most parents and that is why we are discussing it here.

Causes of Diaper Rash – the perfect storm

The leading cause of diaper rash is irritation and dampness to the skin. The dampness is understandable, as a result of the constant contact that ensues when a child sits in a wet or stool-soiled diaper for a prolonged period. Chemicals from urine and feces irritate the wet skin, thus putting the top layer of the skin under chemical pressure. Eventually, the skin breaks out and the rash develops. This happens when the baby’s diaper is not changed frequently (as can happen with an exhausted mother, an inexperienced caregiver or a very busy daycare center where diapers are changed on the clock instead of as needed with periodic checks). Diaper manufacturers do a good job of marketing their products but it only takes one diaper change to know that the diaper can not absorb and keep unlimited amounts of urine away from the skin. Also with stool, there is no absorption and it has to be changed as it happens. Failure to do this results in some of the more nasty rashes that we see. The child’s delicate skin when exposed to urine and feces suffers! The urine and feces once outside the body generate a chemical known as ammonia leading to irritation of the skin (Morris, 2012).

A fungal infection can also cause diaper rash. If your child’s skin is warm and wet it becomes very favorable for the growth of a fungus known as Candida. Just like ammonia, Candida can also irritate your child’s delicate skin. A diaper rash may start up being caused by ammonia irritation and then it is further complicated by a fungal infection. 

The third cause of diaper rash can be linked to changing food and diarrhea. Some infants develop loose stools when a new food is introduced to their diet. With diarrhea, which is frequent loose stools, the wetness becomes even more frequent and this can also lead to the development of a diaper rash.

There are some studies that have linked diaper rash to antibiotics in breastfeeding mothers. Some breastfed babies can develop diaper rash in response to what the mother ate especially if the mother is on antibiotics that result in diarrhea in the child. The suggested mechanism is that the child may have ingested some of the antibiotics from the maternal secretion of her antibiotics in breast milk and then the child suffers antibiotic-associated diarrhea and this leads to diaper rash.

It has also been reported that some breastfed babies may develop diaper rash when they are weaned from breast milk to infant formula ( Gozen et al., 2014).

toddler in diaperSymptoms – check the name, duh!

I say this tongue-in-cheek, but yes, diaper rash symptoms appear to be rash in the diaper area. A facial rash is not a diaper rash and a diaper rash is not a facial rash. So yes there is a rash. However, all rashes are not created equal. Other symptoms will depend on how severe the rash is but in most cases, the symptoms are mild. In the early stages, your baby’s diaper area will start looking more reddened or pink and within a space of another diaper change, you may notice some spots or blotches around the area. Apart from the rash, the baby should appear healthy with no systemic symptoms like a fever. It is not uncommon for an infant to go to daycare with a perfectly normal diaper area and come home with a very nasty diaper rash after 10 hours. In severe cases, the infant is usually very distressed due to advanced and painful symptoms that include increased redness, cracked or broken skin, blisters and ulcers. The rash will spread and cover the entire diaper area, thighs and sometimes up to the abdomen.

 Treatment of Diaper Rash

As I have mentioned above, most are mild and do not require admission to the hospital or an emergency room visit. Your baby’s Provider will focus on the healing of the ulcerated skin, and prevention of reoccurrence.  Sometimes we prescribe a barrier cream be applied on the infant’s skin after each diaper change. The diaper should be changed frequently to prevent reoccurrence. If the infant is in daycare, a discussion with the more senior members of the care team there would help. That way they can ensure prompt checks and diaper changes. The diaper brand may need to be changed to control the source of exposure because though no diaper brand is perfect, not all diapers are created equal.

Other strategies include leaving the diaper off for as long as possible, using only water or alcohol-free baby wipes, avoiding soap, bubble baths, and lotions and avoiding the use tight-fitting plastic pants. Occasionally, the provider may be of the opinion that there is a fungal superinfection or that the rash is due to candida. In such a case, the child will be prescribed a topical antifungal agent and this usually clears up the rash quickly.         

When To Seek the provider

Take the baby to the clinic if the rash is not healing or appears different even after treating it at home. Also if the rash is draining fluid, or you notice white patches that itch or seem to have fluid in it or if your baby is running a fever or cries during urination. These may be indicators that there is a secondary problem that the provider needs to address. 

 

What has been your experience with diaper rash? What did you do?

 

Reference

Gozen, D., Caglar, S., Bayraktar, S., & Atici, F. (2014). Diaper dermatitis care of newborns human breast milk or barrier cream. Journal Of Clinical Nursing, 23(3/4), 515-523. doi:10.1111/jocn.12047

Morris, H.,R.G.N.S.C.M. (2012). Getting to the bottom of nappy rash. Community Practitioner, 85(11), 37-8. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1150212146?accountid=14872

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Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.

Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.

Book an appointment online here.

 

Behavior, Blog, Promotion

Is My Child’s Head Normal?

Are you worried about you child’s head?

Uncertainty about your child’s head can be an uneasy feeling. On your first visit, the provider will perform a thorough head to toe physical examination.

The Top Is Soft

At the top and the back of your child’s head is a soft spot, called the fontanelle. There is an anterior and a posterior soft spot and it can be seen to move up and down with your baby’s heartbeat.  It is okay to touch the spots. It is a natural adjustment that gives the babies brain space as it grows. It is also an important window for the provider during the physical examination process as clinicians can detect illness through it.

Children delivered vaginally may have molding which is just a temporary elongation of the head due to passage through the birth canal. This eventually resolves over the first 24 to 36 hours and is barely noticeable by discharge.

The Eyes

A newborn’s vision continues to develop even after birth. They have dysconjugate gaze which is normal in the first two to three months of life. Your baby may have some redness in their eyes. This may be just because of  some pressure during birth in the birth canal or chemical irritation due to the antibiotic ointment (erythromycin) that is applied when they are born for eye infection prophylaxis. Irrespective of the cause, the eyes are usually clear within the first two weeks. In the clinic, your child’s provider will check your baby’s eyes with an ophthalmoscope and at subsequent visits, clinicians use a bright light to get the baby’s attention as eye reflexes and gazing patterns are assessed. Any visible abnormalities are easily identified.

The Ears

Your child’s hearing will be checked in the hospital before discharge. The shape of the ears may be of concern to a parent, however, if there is a poor development or absence of a part of the ear such as the auditory canal, it is usually identified at birth in the hospital with the initial physical examination. Factors assessed on the ears include symmetry, shape, and size, any skin tags on the baby’s ears. The auditory canal is also looked into to make sure it runs all the way into the eardrum. They use an otoscope for that part of the examination. The baby’s earlobes can bend easily but become stronger with time. Despite the bending it still springs back to its normal shape except in very premature babies and these babies are not let out until they are more mature.

The Nose

Newborns breathe from their nose normally. Sometimes the baby may breathe loudly if the nose is stuffed or if she has mucus, after birth the babies nose may be flattened, which is a normal finding and will resolve in a few days. Sometimes we give parents a bulb syringe to help with clearing the nostrils.

The Mouth

Your baby’s upper and lower jaw should fit appropriately, and when the baby’s mouth is open it should be symmetrical.  The baby should swallow easily during feeding. Also there should be no swelling or lumps in the mouth, the palate (the roof of the mouth) should be easily seen, intact and without any injury.

Judd, J. (1985). Assessing the newborn from head to toe. Nursing, 15(12), 34-41. 

 

What are your thoughts about infant head problems?

Comment below or on our Facebook Page. Please share this article.

Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.

Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.

Book an appointment online here.

Behavior, Blog, Immunization, Infection, Infections, Promotion

What Is All The Fuss About Vaccines and Immunizations?

Your Child’s Pediatrician Is on Your Side

Immunization remains crucial regardless of what the media says. The relevance of childhood vaccinations has been relegated to the background by the antivaccination propaganda, fueled in the mainstream and social media. Providing parents with information on the significance of childhood immunization is becoming increasingly difficult. Many parents are so confused even with the information received on pro-vaccination claims because of the anti-vaccine claims which reduce and undermines their confidence in the system (Luthy, Beckstrand,  & Callister, 2010) These anti-vaccine campaigns are so influential that parents are made to feel guilty when they allow their children to receive vaccines.

Parents, You are in Charge. Get Informed.

Parents have to understand that communicable diseases pose a potential threat to the lives and wellbeing of children and immunization through vaccines have been very successful in health promotion and illness prevention. The media propaganda on anti-vaccination has somehow pushed to parents believe that vaccines pose a greater risk than the diseases they protect against. One of the popular misconceptions is that vaccination causes autism. The Institute of Medicine has released at least 8 reviews that showed there is no relationship between vaccination and autism (Luthy, Beckstrand, & Callister, 2010).  In this post, I will not discuss autism, but it is nice to know that autism is a developmental disorder that affects the brain, manifesting as inappropriate social interaction and communication. Autism is often diagnosed between the ages of two and three years (Luthy, Beckstrand, & Callister, 2010). Sometimes the early signs of developmental maladaptation or delay may be noted around the time of some of the child’s primary immunizations and this in itself has fueled some of the misconception, as anti-vaccine literature tries to link vaccination timing with diagnosis timing and thus string together unrelated events.

Why Vaccinate My Child

Mothers you have carried your baby for approximately 40 weeks in the womb. The moment the child is born, that protection the baby enjoyed while in the sterile womb of the mother is gone. The baby is then exposed to the world full of bacteria and very dangerous organism with the potential to cause harm to your child. Immunization is vital to your child during the first two years of life (Luthy, Beckstrand, & Callister, 2010), and older ages really since the immunity continues to evolve. It is common knowledge that preventing a disease is easier than seeking cure. Protection through vaccination can provide the much needed protection against diseases like Hepatitis B, which can lead to liver failure and liver cancer and Chickenpox (Varicella).

The Diphtheria DTaP vaccine protects against three organisms:diphtheria, tetanus and pertussis. Diphtheria is contracted through breathing contaminated air (droplet infection) from an infected person, causing the inflammation of the pharyngeal passage and neck glands. Secondary effects effects on the heart muscles can lead to heart failure and death. With treatment, death in diphtheria is about 10% according to the CDC while it approaches 50% if untreated. No parent wishes this for their child. Pertussis DTaP vaccine protects against pertussis or whooping cough, which causes a severe cough, runny nose, and a pause in breathing in infants. It can be fatal. You can read more about it here.  Tetanus, the other agent that the DTaP vaccine protects against is also called lockjaw because of the severe spasms of the jaw muscles seen in affected individuals. Exposure through cuts in the skin can lead to stiffness of the neck, difficulty swallowing, muscle spasms, fever, broken bones (the bones break because the muscles contract so forcefully that they break the patient’s own bones), breathing difficulty and death. Tetanus is such a cruel illness because the patient is conscious through the illness. It does not cause loss of consciousness per se, so the affected patient goes through the agony alert, but suffering spasms continually at any form of stimuli from noise, to sound to vibrations. It also leads to death usually by a metabolic acidosis or aspiration pneumonia from the vomiting that the spasms may have caused.

Polio IPV vaccine protects against polio.  Polio leads to paralysis and death if the paralysis involves the respiratory muscles. That was why the Iron Lung was invented to help children breath when they suffered such paralysis. It was seen as a major health breakthrough until the vaccine was invented. Now those Iron Lung machines are found in the museum and nobody has to be in them for months to stay alive because of polio. The Pneumococcal PCV vaccine protects against pneumococcal pneumonia, an infection of the lungs that threatens life in our youngest ones as well as the elderly. Though pneumonia may be treated with antibiotics, its effects are devastating in persons with suboptimal or developing immune systems. In fact, according to the CDC, “…Since routine use of PCV7 for children began in the United States, rates of invasive pneumococcal disease caused by the seven serotypes included in the vaccine have declined by 99%…” .

Hepatitis A HepA vaccine protects against hepatitis A.It is contracted through direct contact with contaminated food or water and can lead to liver failurew. The Influenza (Flu) Flu vaccine protects against influenza infection. It is contracted by breathing infected air, it leads to extreme fatigue and has been seen to cause death in children. Measles MMR vaccine protects against measles, mumps and rubella. Measles is contracted by inhaling contaminated air (droplet infection) from an infected person. Measles has severe respiratory as well as neurological effects that cause significant immediate and long term damage in the affected person. It causes a type of giant cell pneumonia that is difficult to treat because of the viral causative agent as well as the severe inflammation associated with it. Invariably, these patients develop complications with bacterial pneumonia and suffer hypoxemia for prolonged periods. The immunity of affected individuals are often diminished, making them more difficult to treat and making recovery a painful and arduous process for survivors. Other components of the MMR vaccine protect against mumps infection and rubella infection. Mumps is also spread by droplet and direct contact it results in swollen salivary glands and muscle pain. Rubella on the other hand may cause minimal harm to the adult but is devastating to the unborn child. If a pregnant mother who has no immunity were to contract rubella, it can damage the brain, heart, eyes and kidneys of the unborn baby. If the mother does not have a stillbirth or midtrimester abortion, then the offspring, often severely deformed suffers for the rest of their lives.

This brief post should be a wake up call to parents who get carried away by conspiracy theorists about immunizations and vaccines. These vaccines are needed and do a great job at keeping us alive and healthy. While we know there has been an increase in autism diagnosis in the last 15 to 20 years, we must not forget that correlation is not causation. As a parents, you need to join your pediatrician and stand on the same side as your children. These childhood diseases can be devastating. The eradication of childhood communicable diseases is largely hinged on its effective prevention.

I urge you to vaccinate your child if there is no contraindication and save the nation from the pain of a future epidemics like was experienced with influenza at the turn of the last century.

Reference

Luthy, K., Beckstrand, R., & Callister, L. (2010). Parental hesitation in immunizing children in Utah. Public Health Nursing, 27(1), 25-31. doi:10.1111/j.1525-1446.2009.00823.x Retrieved fromhttp://web.a.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=9&sid=2fb73a25-5d35-4a36-9920-f2186b78300f%40sessionmgr4009&hid=4002

 

Here at Omega Pediatrics we have do not fire families that do not want to vaccinate their children.It is, however, important for parents to know that the body of evidence continues to increase and so is the intolerance of vaccine refusal especially among communities and parents that have suffered dearly for a vaccine-preventable illness.

Feel free to call us to talk to a provider about vaccines or text VACCINE to 470-485 7337 for more information.

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What are your thoughts about pediatric vaccines?

Comment below or on our Facebook Page. Please share this article.

Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.

Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.

Book an appointment online here.