At my wits end about dd's nappy rash - in so much pain

[LadyMetroland]

My dd is 2 and since May has developed appalling nappy rash. She gets it in bouts that last about a week, then we have maybe a week or two clear, but then it's back again. During a bout, she is in absolute agony; can barely sit down, walks like a cowboy and is in tears nearly the whole day. Been to doctors four times and am using Canesten with steroid, but to no effect, because of the following:

The major problem is that she lets out little bits of poo throughout the day, rather than one big poo, and so I have to change her nappy very frequently - maybe 8-9 times in a day. She's doing this because it hurts her so much to do a poo that she clenches up as soon as a little bit comes out.

I am using Water Wipes (99.9% water) and am very gentle but it is obviously making it worse to be changing her so often. It also means the steroid cream I put on in the morning has no time to work. There is no time for the skin to heal. I can't let her go round without a nappy for very long because a) she screams that she wants a clean one put on as she knows she's going to let out more poo, and b) she is letting out little dribbles of loose poo all the time so I would just have poo everywhere. Washing her down in the bath or shower is also not on the cards because the poo gets stuck into her skin and needs some kind of gentle wipe, but also because she literally screams blue murder, as if she is really being hurt, if I take her near the bath or shower (I do give a bath before bed, with salt in it, but I have to force her into it and hold her down which is just awful)

Bepanthen etc has no effect because it just slides off the affected area - the area is so red and weepy that cream just won't absorb because it's just raw.

Tonight she has screamed in agony every time I've changed her nappy. She is in constant tears and it is absolute agony to watch. I even considered taking her to A&E to try and get some kind of local anasthaetic or major league painkiller for her (obviously didn't do this but I am desperate)

Does anyone have any advice or experience? I'm off to the docs again tomorrow morning.

Elportodelgato - I am ready to go nuclear! Only concern now is someone upthread said steroid cream would be making it worse if infected. Can the gp do a swab for infection and get results immediately or does it take days at a lab? She had antibios at one point and that was a nightmare as the taste was so foul we had to pin her down and syringe it in, so I really hope it's not infected

Timodene with a thick layer of Sudacrem over the top as a barrier works well.

YY definitely try breast milk! My DD had cuts on her face from the forceps, she managed to knock one of the scabs off several times & it got infected. I used BM at every feed & after baths, infection went away. It was a lot more gentle that any cream, they all looked like they would sting. She has scars now but they are not too bad. You just smear it on with a clean finger - although you may find it more practical to express & use cotton wool.

If your GP said they thought it was thrush (so fungal nappy rash) have you tried Canesten? That would eliminate the problem if it was. Fungal nappy rash is very red with quite clearly demarcated lines - do a Google images search.

If it's not fungal, perhaps the GP can prescribe an antibiotic cream? Have you given that a go too? I'm surprised you haven't been given either / both...

I was told dd had thrush for 18 months funnily enough it only ever improved when we used canestan with hydrocotisone (steroid) in it. In the end it was Strep A - called perianal strep - she had every f*cking symptom, in the end peeling skin. I potty trained early, she then developed psoriasis at 2.5 - I think triggered due to suffering strep A for so long then getting chicken pox -grrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr. Please do demand swabs to rule strep and other infections out.

It sounds like your dds stools are too loose so either she eats too much fruit etc or as others have said a food intolerance - dairy is a classic for either constipation or very loose stools.

All the best.

I would also eliminate all harsh chemicals from the bathroom, and house.

Use only ecover washing up liquid diluted in a spray, the ecover bathroom cleaner is also OK, then reuse the bottle with washing up liquid,

don't allow any harsh shampoos, soaps, shower gels, in the bathroom, pop along to your health food shop for safer products, make sure that the space is really well rinsed, before she uses the bathroom.

we don't allow any harsh cleaners in the house and DD skin issues are a thing of the past, if we go anywhere that uses the standard cleaners, she immediately starts to flare up.

don't rub any nut based products on enraged skin, or risk allergies.

CAn you bribe her to sit on the potty for a longish period of time with a DVD and some treats

Thanks all. Doc said it is very definitely fungal so am trying Daktacort with 1% steroid. Today the rash had improved very slightly and she is in good spirits except when happy is being changed. So at least that's something. Doc also suggested reducing fruit intake so I may try limiting it to 4 -5 portions a day rather than her current 7-8. Potty training will begin after we're back from holiday. Thanks for all the tips.

So on looks alone he "knows" it is fungal...

Here is some info and photos, plenty more on google - perinal strep www.healio.com/pediatrics/journals/pedann/%7Bbb0a72bd-95bf-40f3-8c91-2c957862ac91%7D/perianal-dermatitis-much-more-than-just-a-diaper-rash

That is a lot of fruit though!

Old fashioned Zinc and Castor oil worked for mine. It acts as a barrier and the zinc supports healing. Burt's Bees did a good nappy cream also, which I think contained Zinc.

Reducing fruit and veg, and increasing "brown" foods reduced the times DS1 did a number 2, and improved the consistency.

My other thought, you mention that it keeps coming back. Is there any way you could put in some maintenance routine to try and limit any further occurrence? Not sure quite how, but thinking along the lines of oat baths, gentle barrier cream (bepanthan fans here, and think they do wipes?), and trying to sort the no2s so she can have some nappy free time.

Hope it improves soon.

It sounds to me like a lot of the problem is her frequent pooing. Poo can be v acidic and literally burn the skin leaving it red raw. If she is not constipated and is pooing a good amount, just very frequently, then try googling toddler diarrhoea. There is lots of info on the internet. It may be her diet is actually too high in fibre,fruit etc. My Ds had this and by introducing more fat into diet and less fibre his diarrhoea improved dramatically, then his nappy rash cleared up.

I stopped wholemeal bread, and gave 50:50bread. no weetabix, no oats, no grapes,raisins, no baked beans, no sweetcorn, no peas.

also worth another visit back to gp for a skin swab and prescription barrier cream or spray if metanium doesn't help.

To clarify - she would have 7-8 portions of fruit and veg in a day easily

banana or raisins at breakfast
cherry tomatoes, cucumber and red pepper strips with lunch
grapes as snack
peas and carrots for tea with melon for pudding

she is fussy in all other areas of eating so I've always been pleased she likes her fruit and veg. Today though I've given her sausages and potato wedges for lunch and will try to avoid giving large bowls of fruit later.

Erm... Not trying to be nasty as you are clearly very worried and doing your best... but 7-8 portions of fruit per day is surely enough to give even adults a sore bottom.

See what happens if you reduce it to a maximum of 2. Replace the rest with veggies.

Oops, sorry - I see that's 7-8x fruit and veg. Perhaps leave out tomato and only do 2x fruit?

I would cut out tomatoes, raisins, grapes, acidic fruits like pineapple and citrus fruit. Peaches, plums, apples, apricots, bananas and melon should be okay. You may also find that reducing the quantity of fruit reduces the amount she goes poo.

Metanium is excellent, but if that is not working my SIL told me in the SCBU where she worked that they used Orabase in cases of severe nappy rash. It is a protective paste designed to adhere to raw and weeping areas so won't slide off and will protect the skin against urine in between changes.

I used to use chamomile tea bags to make a soothing bath.

My DD used to get really really raw skin from frequent loose stools. We cut down her dietary fibre (no brown bread or wholemeal pasta, cut right back on fruit and veg) and upped her dietary fibre and it changed things within days. Google toddler diarrhoea, as someone else has said. And the second she is a bit happier and less sore, leave the nappy off for as much of the day as you can manage to let her skin heal a bit. Poor mite, it is miserable :(

I wouldn't necessarily agree with apples etc being fine, as with us the problem was the amount of fibre as well as the acidity. I would cut right right back for a few days, to hardly any or even no fruit and veg - see what difference it makes and then gradually add it back in till you know how much she can tolerate. Good luck.

Is she teething as well? Ds gets terrible nappy rash even now (age 8) when he is cutting a tooth.

Things that work for us - metanium is terrific. Really really good.

Damp cotton wool laid on the rash - not wiped - and dabbed.

Anything with a beeswax base - lip balm etc as a protective layer.

I also wondered if giving her teething powders would help reduce the acidity of her stools?

I would still want her swabbing though as dds strep A did look like thrush/fungal but wasn't hence it never really went away.

Veg is good, fruit is baaad for nappy rash. I've experienced it with both my dcs, especially juice and citrus fruits. The resulting poo seems to burn the bum almost immediately. Its great that she loves fruit and veg, I have a fussy 2yr ds old too so know how you feel! He's suffering with it at the moment after going ott on the orange juice yesterday.

Personally I find leaving the nappy off for as much as realistically possible helps the most.

My dd eats a lot of fruit and veg too - we tries increasing the fat in her diet and switching to white bread and this reduced her runny poos significantly so we didn't have to cut the level of fruit and veg in her diet. Google toddler diarrhoea and it will explain about it.

So, she's still in pain but the raw area is slowly reducing. She only did two little poos today, presumably because she hasn't eaten fruit and veg (or her usual porridge and brown bread) for 36 hours. So the skin is getting time to heal. It still bleeds where I wipe though, the doc said repeated use of steroids will weaken the skin which is what i think has happened.

Toddler diarrhea is possibly what she has. Her stools have always been loose whereas her sister does one perfectly formed poo a day (possibly tmi there!)

The strep A comments are interesting. If this thing returns again I will ask about it.

Not sure if anyone has mentioned. Medi honey is another alternative to try ,can work really well on bad nappy rash. Although if loose stools continue it may be hard to treat . Try exposing skin as much as possible ( if you can ) .