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.

Absolutely don't want to be alarmist, and it sounds like your DD's rash is on the mend but wanted to raise awareness that very severe persistent nappy rash can occasionally be caused by high concentrations of sugar in the urine due to very early onset type I diabetes.

If I let DD3 have kiwi fruits her poo seems to actually burn her skin, it's awful to watch them in pain from something they have to do . Tea tree and lavender essential oil in the bath can promote healing I think.

Try sorting the poo problem, too. That can't be helping. Movicol on prescription will clear her out and stop the 'overflow' problem.

I swear by metanium-rash has disappeared by the following day but be careful because it really does stain.

can you sit her on a potty in front of a favourite film each day, so she's getting an hour without the nappy and the poo will then go straight into the pot? Maybe that will help her with the potty training and give her bottom a bit of air time as well...
re metanium - pat it on with your fingers, don't rub or smear. you're trying to get a sort of thin stipple effect

another vote for metanium cream. We called it bionic bum cream (it's three kinds of titanium!). I recommended it to a friend whose DD had suffered for months, and it fixed things for her too.

Also, another vote for sorting out the withholding, if your GP agrees that she is. Movicol, and for at least as long as she's had the frequency problem, not just until it clears up initially (cut down the dose gradually, only once a week - to get graphic, when her motions get too soft and perhaps her control goes a bit - night poos were a dose-drop sign for my DD). Any child who poos only once a day on any dose of Movicol is still withholding. The plus side of the withholding is good strong muscles and fewer accidents during potty training :)

Good luck!

I really think you should

oooops! insist on a swab for strep A. There is no way of knowing the rash is fungal from looking.

Also, if she is having 'overflow' poo, she may have fecal impaction. Did the GP check for that?

bit of prune juice diluted or pure orange juice/white grape juice works wonders. If she likes raisins or sultanas or grapes they're good also. U may have to encourage her to take it. Certain foods increase the problem in my daughter I've noticed too much banana, too much fibre isn't good either or too much white foods. Stick to whole meal bread or 50/50.

Also I think it's coz they're little bodies are still adjusting this sort of proble. Will occur sometimes. Also make her drinks lots of water or whatever juice she likes.

Sit her in the bath I find rash disappears by next morn if this is done often enough. Also helps her open bowels after.

I tried all nappy creams suggested then I ditched them all. Went back to cotton wool and water dab dab not wipe hard. Pat bottom dry with tissues. Then apply generous layer of Vaseline petroleum jelly followed by a generous layer of sudocream don't rub in too much lece it looking white. If using a cheap nappy like I do just for the nappy rash interim use a better quality I.e pampers. in one night you should see an improvement. I swear by it. It's all I ever use. My daughter was the only child of 4 who had nappy rash I also think its due to constipation and nothing else.

I always just used a thick layer of Sudocrem. Never went any further into needing a prescription would just clear up right away.

Seriously, if she is in such discomfort (and it sounds horrible, poor you and poor her) this has gone beyond metanium and prune juice. You need proper medical advice (and possibly a second opinion) from a GP.

The white of an egg does wonders

LadyMetro I've just caught up with this thread and have no advice except to say I also have 18 mth dd who is in agony and I'm taking her to docs tomorrow. I'm convinced its more than nappy rash after 3 weeks of her clawing at it constantly, screaming in pain in the bath (I can no longer bath her at all) and I've tried loads of creams including anti fungal from pharmacy.
I can't actually leave her nappy off at all now either to get some air to it as she rakes and rakes at it if i dont pin her arms away. You have my sympathies as its awful to watch.
Persist with your gp and get a second opinion as that's what I'll be doing I think.

Not read whole thread so maybe already suggested but we found fifty fifty cream from chemist which is a diluted Vaseline brilliant for ds when a newborn with appalling nappy rash.

Knotted my dd was the same. It turned out to be thrush. Canestine was not strong enough so she was prescribed trimovate which worked quite quickly compared to anything else. it didn't completely get rid of it though - it would come and go until she was potty trained. Once it started to improve we just made sure that her bum was heavily moisturised at every nappy change and also every evening we applied a thin layer of the trimovate too at the smallest sign of it returning.

It's awful to see our babies in so much pain - bathtime was awful as dd would scream and cry in agony when her wee bum hit the water but actually we persevered with it as once she was submerged for a little while it soothed her bottom and we carefully patted her dry before slathering cream on.

Hope you get on ok at docs. Keep going back until it improves.

Re toddler diarrhoea, my DS suffered badly between the ages of 2-3 with several loose "burny" pops a day.

The only thing that worked was cutting out fruit. Grapes, in particular, were guaranteed to cause problems. We also introduced more white bread to his diet. It's counterintuitive but it worked.

Do try and get it swabbed. You can do it home and drop it in to the surgery.

I would also try metanium which is a zinc and castor oil cream incase you struggle to find the brand. It's winder stuff.

DS will do the little and often poo thing (resulting in horrible nappy rash) when he inadvertently had dairy or soy and he's allergic to both. It's a sign that he's come into contact with them.

Hope it clears up, hate when they have sore bums.

Thanks harver I've been prescribed timodene (spelling?) but today she started with chicken pox too so she's now also slathered in calamine aqueous cream and now her eczema has gone wild! I can't tell where one rash ends and the next one starts!

Hope everyone's bairns are coping ok, I don't think the humidity is helping either. Doc also said keep hydration levels up so wee doesn't become concentrated so I'm pushing the sippy cup big time too.

Da had v bad chicken pox all over genitals and also susceptible to nappy rash and GP prescribed double base dayleve gel which was helpful. That's a brand name but it says on it isopropyl myristate 15% w/w liquid paraffin 15% w/w

So much advice already op but my tuppence worth is to use the fungal cream for as long as recommended. Dd had recurring nappy rash, doc always said it was fungal but it never cleared up. We were anxious about using the steroids for a while. But one time we decided to go for the full 10 days of proper dose and it hasn't been back since.

So long term huge gain. Rather than messing around nearly clearing it often.

Its horrid, you all have my sympathies

Try Elizabeth Arden eight hour cream skin protectant. Expensive, but worth it. Discovered it when it was all I had in my bag. If 2yo not allergic to nuts, cleanse with almond oil, or olive oil. No baths or showers. Try 1 day at home, sanitary towel inside well fitting pants. Just remove poo from parts of skin, don't clean all bottom or vulva each time.

What about try a cloth nappy with a fleece liner for a few days - do you know anyone who could lend you one. I means you can change the liner only rather than the whole nappy if there is a little bit of poo and there are no chemicals touching her skin.

Poor, poor, poor little poppet. There are 3 problems here: diet, wipes and the rubbing of the nappy.

You must change her diet. Include as much fresh fruit as you can, especially oranges (the pectin in oranges turns to jelly and absorbs water). Oatmeal porridge when you can (oatmeal also turns to jelly in the gut and absorbs water). Dried fruit, like pears are fine and give her lots to drink. Lactulose in orange juice.

Throw those wipes away. Never use them again!
Try and have her without nappies as much as you can.

For the nappy rash itself:

Put her in the bath to rinse as much of the chemicals and oil from the wipes/urine/faeces as you can. See if she lets you use a bit of soap, but don't push it.

Then, take a hair dryer and gently blow dry the area thoroughly. Make sure you put your hand in front of it to check the heat. Dry in all the skin folds (the children enjoy this).

Put whatever barrier and healing creams you chose (suggestions above) onto this perfectly clean, perfectly dry skin, and blow dry again. Put a second layer of barrier cream on and blow dry.

If you don't thoroughly clean and dry, you are trapping corrosive stuff under the cream and it doesn't resolve the rash.

LEAVE THE NAPPY OFF preferably till bed time. Dont sweat the small stuff. Whats a little wee or a little poo in the bigger picture of healing?

Honestly, wipes are terrible both for skin and the sanitary infrastructure. Use cotton wool and soap and water (then wet cotton wool to thoroughly rinse) preferably. Sometimes the old ways are best.

PS what is corroding her skin is 4 things: uric acid and urea from her wee, fungal spores/bacteria feeding off the proteins fats and carbohydrates from her poo and giving off acid as a byproduct, the silicone and other chemicals and preservatives in those thought up by Satan wet wipes, and the physical rubbing of the nappy.

That is why the soap and water clean, rinsing and thoroug blow drying is so important, to put cream on clean, dry skin. It sounds crazy, but it works!