15 day old extreme nappy rash help

[CloeAndJack]

This has probably been posted 1000 times but I'm having a huge struggle with my 15 day old son.
Since near enough day one he has had a nappy rash on his bum which has been getting progressively worse and spreading up to his legs. He also has acne around his eyes/forehead quite badly but don't think that's relative.
I've been doing warm water and cotton pads for the past week, I have to resort to gently using a cotton bud to try get his bumhole clean because it's the only way I can get near it without him somersaulting or locking his legs straight mid air.
First tried bepanthem, then sudocrem, then metanium to no avail. The midwifes said it was nappy rash, the health visitor said it looked thrushy so he has been prescribed clotrimazole and that doesn't look like it's working either - can only put that on max 3 times a day. He was 9lb12oz, is now 10lb10oz and taking between 60-120ml of aptamil every 2 hours, it used to be 3 hours. I am putting him into size 2 nappies now, going from Pampers to Aldi ones to see if this helps. I have tried no nappy time as much as I can but when he is peeing once every half hour it's really difficult and I can't watch him constantly.
By the time I feed him, burp him, multiple nappy changes, I have half an hour if I'm lucky until he wants his next feed. He's only 15 days old and I feel guilty because I'm at my wits end because he is so sore, it's almost his whole bum at this point and he has a complete meltdown during nappy changes. He was a very content baby before this got to this stage. I try to make his changes as quick as possible but he's as strong as anything with his thrashing then when I go to put the new nappy on he pees and I have to start all over again and I'm scared incase I'm not cleaning him enough incase that makes it worse but I'm still gentle, trying to pat more than rub. I have to sit him in front of a fan heater which is enough away from him during the nappy changes aswell as this seems to settle him slightly even though the temperature in the house is 21 degrees, so he is very pampered. Lol.
His poos have went in the past week/few days from being yellow with solid green grit and not terrible smelling to now very liquidly yellow, hardly any grit and they smell atrocious. He whines and almost cries before doing either a poo or pee too and is extremely gassy from his bum end.
He is extremely uncomfortable, will hardly settle now, squirms constantly and I feel awful.
Also if he does a poo say mid feed after having 60ml, he then wants another 120, is this normal since he's emptied his bowels?
I'm phoning the doctor on Monday.
I'm worried now incase it's a milk allergy.

Has anyone got any tips or suggestions? I would really appreciate it.

Regards,
C

Oh my god @CloeAndJack I'm actually really angry on your behalf

So they let you leave the hospital knowing your baby has an allergy to milk? But still advised to keep feeding baby the milk and speak to the gp in 2 days?! Unbelievable some people!!

You're doing everything right - bless you. There's nothing you can do if you've asked for help, been given advice and followed it. You're doing the best that you can

If it was me I would be going to boots as soon as they open and buying a cmpa formula from the shelf until you get a prescription from the gp. I know there's an Aptamil Pepti 1 you can buy. Short term solution until you sort this out with the doctors

Ahhh I'm really really mad, your poor baby!!

I don't understand why they couldn't write you a prescription for Nutramigen so you could get it when any chemist opens. Now you'll have to call and wait on a gp to write one. Why couldn't they have just done it tonight. So bad

I'm not happy myself either, considering it's a health service as a whole you'd think the doctors at the hospital could prescribe you something then and there so I could pick it up from an emergency pharmacy tomorrow even if I had to travel but they don't.

Is there any formula you recommend I can buy? I would rather buy something for him tomorrow but I've tried to look and because there's so many different ones some for mild allergies etc which still have cows milk in them I have no idea what I could pick up for him from somewhere.

Thanks,
C

If your baby is using disposable nappies which most of us use

Then do not ever use a cream like sudo cream

Disposable nappies are leak proof so putting cream on just causes the area to sweat more and breathe less making the rash worse and unable to clear

Carry on with what you're doing with water and cotton wool

I know, it's awful. I never said anything except "So he's just going to have to suffer until Monday and basically starve since it's running through him" and he answered that because of his size "It's not like he's going to starve, if anything he's actually eating too much which is causing more diarrhoea".
The doctor wasn't that bad when explaining the plan but certain thing he said I wasn't too happy about like the fact I've to cut down his feed the only reason to stop giving him as much diarrhoea...

STOP APPLYING ANY CREAM OR LOTION ETC

Re formula try Aptamil it's considered one of the best and least likely to cause issues

Do not use organic formula

The organic bit means there is a nutritional legal loophole so it's missing loads of nutrients required in a normal formula. Avoid.

If however you find issues then try Cow and gate

There's a difference between allergic and sensitive re PP so a GP will still recommend something that you might be sensitive too because it's never going to kill you if push comes to shove ie not wanting to starve

I'm only familiar with Aptamil Pepti 1 and Nutramigen. You can buy both but I'm not sure where would stick to buy instantly

Maybe someone can advise - Can 111 send prescriptions to chemists? If so I would be on the phone asking for ds to have this done to collect tomorrow so he doesn't have to suffer. It's not right, I can't understand their logic

Can you post on any local baby groups to see if anyone has spare or leftover cmpa formula? That you could buy to replace when it arrives?

Ask your health visitor / midwife / GP about possibly using infant lactase drops which breaks down the lactose in milk including breast milk

@CloeAndJack glad you've been seen and it really does sound like milk allergy, my son didn't have the rash too and it can throw doctors when diagnosing but the diarrhea with every bottke was exactly like my son, and pools of foul smelling yellow poo in his nappies.

What milk have they put him on?

My son is on aptamil pepti syneo after he refused aptamil pepti 1 due to the flavour. They're very thin so adding carobel is often necessary, but depends on how your boy keeps it down. You can't buy them over the counter, you can krder online but they're about £30 to £40 a time and by the time they arrive you'll have got the prescription.

I'm not sure what they will be putting him on, should I ask specifically for something? I've read a lot one of them tastes foul and a lot of babies refuse it, I don't really want that scenario on top of everything else that is going on.

It could be CMPA.

It could also be a fungal rash.

I don't think you should wait until Monday to get him seen.

Cotton diapers unfolded under baby. Cotton wipe laid on top in case he pees so things don’t go flying.

old towels will work too if you don’t have access to cloth diapers.

then just wash and reuse

if baby has very sensitive skin from the rash or skin allergies, disposable products can be very harsh.

My nephew had a mild milk allergy and was put on goat’s milk formula which massively helped him - kendamil do one but I’d be wary about changing to that just until Monday. It might be worth trying long term though. His symptoms were very similar to what you describe, plus the terrible congestion and constant runny nose which meant his face was always sore too.

He did eventually wean onto cow’s milk when he was older but it resolved all mild allergy issues when he was under a year old. Hoping your GP can sort this for you as quickly as possible.

My baby had the exact same, around the same age and it was a cows milk allergy. I left his nappy undone at the back, but pushed against the front to catch wees and held him on my chest for most of the day, so any poo didn’t touch his bottom and make him more sore. It was messy, I was changing the nappies constantly and meant I couldn’t do anything else but hold him, but I was desperate. I also used cavilon which is a miracle spray and helped to protect the sores from the rash. It was recommended by the paediatrician we saw in hospital.

As soon as he was on (the right) prescriptive formula the diarrhoea stopped and he was sorted. A warning, though, that nutrinagen does still contain broken down milk proteins and so some babies may still react on it (both mine did). So if he is still experiencing symptoms, push back and get an amino acid formula such as Alfamino/ Puramino/ Neocate. I was prescribed the formula in the hospital and given a tub to take home straight away from the paediatrician so it’s upsetting to hear you haven’t had the same- hope you’re not waiting too long until you can get it as I know how distressing it must be to see him in pain.

Is the syneo one that can be prescribed? Am I better off specifically asking for that one? Said previously I don't want him refusing to eat on top of everything else.

Thanks

@CloeAndJack it's prescribed yes but they have a ladder they follow, aptamil pepti 1 first, the syneo then not sure as ny son ate the syneo ok, not with the gusto he ate kendamil but that was hurting him. It depends how bad his allergy is as these formulas still are cows milk, the proteins have been heavily hydrolysed to make it easier to digest.

An amino acid formula is for very allergic baby's and that onentastes terrible apparently, but your son sounds like mine with no rash so probably will be on aptamil. Syneo is more expensive to the NHS according to my hv as it has a probiotic so they don't prescribe first but if your son hates it and his feeding drops just push for next formula on the ladder.

A friend of mine puts a drop of vanilla essence in hers to improve the taste and that has worked.

There is some misinformation on this thread.

Lactase drops will do nothing for CMPA. Lactose very rarely affects babies, CMPA is to do with the proteins in the milk, not the sugars (lactose).

Aptamil is no better or worse than any other first stage formula. Some babies find some formulas more palatable but that’s about it.

There is not a ‘legal loophole’ with organic formula.

https://www.firststepsnutrition.org/parents-carers

We had this exact same thing. Coupled with reflux. Gp recommended infacol before feeds for gas and relief which helped massively it was like he was different baby!

For the rash, we ended being prescribed a very mild steroid cream which cleared it up within 3 days completely. I was nervous about using steroids but I was desperate and he was in so much pain.

Baths with a little baking soda helped as well and then hair dryer on cool to dry after baths and after every nappy change before putting cream on. Bum needs to be 100% dry. And nappy free time a couple of times a day. I just draped as muslin between his legs to catch any wee.

I'm not sure if it was a milk allergy, like yours he didn't have any of the other symptoms. He put weight on slowly as well. I had to eliminate dairy from my diet, onions, garlic and other foods that caused gas. Stuck with aptamil.

11m on and haven't had another nappy rash and reflux is still there but much more settled and he's a happy, chubby baby.

GPs wouldn't prescribe anything or do further investigations because baby put weight on and seemed fine. Was told all babies are somewhat refluxy, and that spit up was normal and can be lot and many times a day. It's been a journey and it's horrible especially in those early days when they are just so helpless.

Hope you guys some relief x

I am so so angry at the health 'care' you've received. It's outrageous. Please complain to PALS.

I was told to keep breastfeeding and just remove the foods from my diet because it was unlikely my 4.5 months old would accept the formula. Breastfeeding and the diet destroyed my mental and physical health and we had no choice but to make the switch at 10 months. For us the bottle was much more of an issue than the taste.

If you were moving a 6 month old baby on to the formula I possibly would be concerned and slowly titrate the new formula in - 1oz prescription formula and 4 oz of regular then 2oz and 3oz , 3oz and 2 Oz, 4oz and 1oz and then just the prescription formula. If they don't take to the formula now you could do this with baby only being a few weeks old you probably won't need to do this.

You need to start with an extensively hydrolysed formula. I think the most common ones are pepti and nutramigen. If you search for your NHS trust and cmpa you should be able to find a prescribing plan which tells you the preferred milks they try first. I would avoid goats milk for the time being. 90% of babies with a Cmpa will react to all mammalian milks. There absolutely will be babies in that 10% who thrive on it but it's a strategy that is more likely to prolong the discomfort. If it's something you would like to try I would get settled on a dairy free formula and then test it to see if they are ok with it.

Hi everyone, another update. Thanks for all your replies. I ended up back at A&E this morning at 8am after another 111 call as his diarrhea was awful and he kept me up last night screaming for food every half an hour but every time he ate he diarrhea-d it all back out. He was taking a full 120ml bottle of aptimel and pooping it out instantly during the feed.
I got seen by what I assume was a more senior doctor who got a bottle of apti 1 made up for him to eat while there as he was starving, gave us a tub away, another tube of metanium and a prescription for 8 tubs of aptimel apti 1.
I'm honestly livid that wasn't done the night before and they expected him just to suffer until Monday. I did phone round pharmacies and the only one being open was Lloyds, you can buy apti 1 over the counter which is what I would have done if that doctor hadn't gave him a tub so he could actually eat.
I've to slather his bum in metanium as it's being used as a treatment so to not follow the box instructions of a thin layer.
That's to be completely removed/ refreshed once a day with a bath. Poo has to just be wiped off it, the same with pee and it lathered back on. He never mentioned nappy free time but will try some of this during the day tomorrow.

Generally to summarise incase anyone else has this issue which is at least in this case a milk intolerance.
Extremely watery yellow horrific smelling poo, red raw nappy rash spreading to legs. squirming / gassy the moment he sooked on the bottle, you could hear it going through his system. Would poop it out during feed or straight after. I'm pretty sure this has all started happening within the past 5 days as he did have solid poo for a few days however his nappy rash has been there earlier than that and tried everything, and it's got progressively worse. Was only having the odd spit up and was relentlessly farting. Quite congested, not sure if that's relevant. That's about all I can think of.

He has had 4 bottles of apti 1 now ranging from 60-90ml and is keeping it in and is sleeping by the looks of it a bit better. I noticeably saw a difference in him the moment I put the bottle in his mouth as I've been so hyper vigilant over the past few days. He has done a small poo which is miles better than the explosive diarrhea so it is working.
He is still congested however I will be using saline drops and a snot sucker on him which I've used before to try and see if that will help.
I have been rubbing his stomach occasionally and it is obviously still sore inside, also hoping this calms down.
I think it will just be a waiting game.

I don't think he likes the taste so although I do think it's helping him, he is still occasionally struggling and I think it's down to this plus maybe a bit on the lines of his poo being now more solid so might be a bit harder to squeeze out with his bowels/stomach being so sore. Not sure if to try vanilla essence in it like I've seen others mentioning on different posts but wouldn't know the volume of essence to milk to use. I will mention this to the GP that he's still sore now trying to poo.

Will now have to keep an eye on his poos going from too liquid to too solid and try and get this nappy rash under control then hoping that's him.
Our GP has been sent the "ladder" so will be following that.

Aw @CloeAndJack I've come back for an update and so pleased to see you've just posted
I have been thinking about you and your little ds and I am still so angry for them fobbing you and your starving allergic child off till Monday! It really is unbelievable

You've been a great advocate for your baby so well done for getting through this. It will have been so tough when all you want to do is take the pain away and can't

Great mum xx