Is this baby acne or cmpa? Please help!

[ThisIsLJ]

Hi everyone
I have looked at several threads on this and can’t seem to see a rash I think looks similar.
Took DD to gp yesterday for this rash which she has had for around 2 weeks that never completely goes but flares up and calms down.

The doctor wasn’t much use but gave us some of that aptimil peptide 1 to try for CMPA (she is combi fed so would also need to cut dairy)
Her poos seem normal, she does have some discomfort at times during feeding and can cry and scream for an hour or so a day. At night she is very grunty and squirmy. She is breastfed over night with a formula before bed.

Anyway I am reluctant to change both our diets if it’s not CMPA but will give it a go if I have no look with moisturising the rash and seeing if it improves.
has anyone had anything similar? Any advice is much appreciated. The pics attached are the worst I’ve seen it.

That definitely doesn't just look like baby acne to me, I would probably have guessed at allergies

How old is she?

It's a tricky one as it looks a bit like baby acne but it's quite dense and going down to the shoulder is unusual.

Is the rash anywhere else?

I would start with seeing a breastfeeding specialist to help with latch to make sure she's not taking in too much air and is as comfortable in her tummy as possible. Remember that if you BF it will take about 2 weeks for the dairy to be completely gone from your milk.

Thanks both.

@CocoPlum she is 6 weeks old. The rash is on her face, chest and back a bit below where babygrow is.

That looks very similar to my DC’s (likely) CMPA rash. I’m now EBF and since cutting out dairy it is basically gone, and the squirming and discomfort overnight has reduced significantly. It’s worth cutting it out to see, it takes 6 weeks to leave your/their system completely.

I would look into (please don't be scared by this wording) toxic erythema neonatorum (the "toxic" part is a misnomer left from the original hypothesis!), although she's a little old for this. I'd be more inclined to think it's a bad case of baby acne. She was 4 weeks when it started which is classic timing. Are her poos normal?

I don't want to say it's not CMPA as I'm not a medical professional but I am very experienced in breastfeeding support where I see lots of mothers with babies around this age who have baby acne, typical baby night time grunting, and gassiness wondering if their baby has CMPA. Often a tweak to get a deeper latch can help the baby take in less air when feeding and be a little more comfortable, so my first recommendation would be skilled BF support before you start depriving yourself of milk and cheese.

The CMPA group on Facebook is very knowledgeable and useful - you might find that a better resource to speak to people who have been in your position

What are the poos like?
Cmpa was dismissed for ages with my daughter as her poos were "normal" they weren't they were just normal for her, it was during covid so I didn't see anyone else. No one gave me any descriptors for normal.
At point of diagnosis her only symptom was her being a very unsettled baby crying for most of the day.

It could be cmpa and unfortunately the only way to rule it in or out is to remove dairy. What I would do is start a food diary and see if symptoms vary depending on the amount of dairy and soya you eat. I was mostly vegetarian and ate a lot of soya meat replacements especially when we were having a bad week as we lacked the headspace for dinner. 2-3 days later she was inconsolable, over 2 weeks there was a very clear pattern of soya - very unhappy baby.

My daughter also has silent reflux and that was also a big cause of her crabbiness - hers is in addition to allergies rather than causes by allergies.

It takes 8-24h for milk proteins to clear your milk and reactions typically take 2-72h so you can often see hints of improvements within a week or so. It can take several weeks for the body to heal from the prolonged exposure to the dairy proteins so you can still get symptoms for 3-6 weeks. Half of babies are also allergic to see so you have to be careful about not doing a straight swap to soya products when removing dairy initially.

As they are combifed you might actually find that it's only the formula that needs swapping and not your diet too. Not all babies will react through breast milk.

Did the GP give any other suggestions? It might be worth trying the formula and starting the food diary before taking it out of your diet and look into other causes alongside this in a multipronged approach. If things improve you could try switching back to regular formula to see symptoms return.

I held off removing foods until 17 weeks as i was told by the GP it definitely wasn't anything in my diet. I first went at 6 weeks, symptoms started at 1 week but subtly and didn't get problematic until 3-4 weeks. We went stepwise through physical reflux, slow letdown, fast letdown, different reflux treatments other things I've forgotten. If I had my time again I would have rathered take foods out of my diet unnecessarily than wait and have needed too. In the end it was silent reflux and allergies.

I was told my baby's poos were completely normal too!
month and months on and a very long stressful journey to be told CMPA!
I think stop the formula and cut it out your diet also for two weeks and see if there's an improvement.

@ThisIsLJ sorry to hear this! My 6 week old looks EXACTLY the same right now. I’ve been to the GP twice. Did you find a resolution? Xx