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

I'm so pleased you have got some formula. You might find that the extensively hydrolysed stuff isn't sufficient. Give it a week if you are still in a pickle push for an amino acid formula you want neocate or alfamino.

We did cloth nappies and we didn't get nearly as much nappy rash then as we did when we did when in disposals. You can fashion quite crude nappies from any muslin if you want a break from the nappies but with a little containment.

@CloeAndJack great update glad you got the pepti! It takes a whike to flush his system and he won't eat as much but part of his eating will have been to soothe some inevitable reflux. My son dropped briefly a few centiles but went back to 91st quickly and has stayed there. Best of luck with him, hope you have a happier bubs :)

I have noticed this with his poos and went into panic mode again because he is still pooping quite a lot.
It isn't as bad as it was, it's not as liquidy and as strong smelling but it like a lesser version of what it was and isn't irritating his bum as much. Was going to phone 111 again as I'm turning into a helicopter mother lol but since you've said this it's put my mind a bit more at ease.
He is still acting as if he's starving but tried to give him a bottle there and he took a little and spewed it up. So I think he's just being greedy so will just have to "starve" until his next feed.

It might take 4 weeks to get to normal but you should see a steady improvement over the coming days and weeks.

You might need to thicken the milk as they can trigger reflux so something to consider if they continue to be desperate feed on the prescription formula. My daughter had reflux in addition to reflux and still needs milks thickened aged 3. The downside is they can cause constipation and for us the use of gaviscon masked some of my daughter's allergy symptoms as it looked like she wasn't getting the loose poos as much and slowed down her diagnosis of allergies

Are you a doctor? My doctor recommended ONLY sudocream except a mild steroid twice per day when my baby had terrible nappy rash. It worked. We used steroid cream for 2 weeks and now only use sudocream.

my advice is to see a GP who will make a referral to dermatology as well. It may not be needed, but best to do that too just in case. They should swab the rash. If it is a bit white it is likely to be thrush. Ask for a lactose free formula prescription asap.

We were told to only use sudocrem occasionally by gp and paediatrician as it dries the skin and we were having to use other creams to combat this. She was fine with it saying once a week but more than this we were noticing that she had dry skin

Thank you, I feel as if I've let it go on longer than it should have but honestly some things you just put down to new baby system adjusting as that's what you're told by all the health visitor people otherwise you're "paranoid" and "post natal". When I smelt that poo I was like there is no way that is normal, it smelled like death and it was literally water. Before that one it wasn't that stage. Everything progressed quite quickly over a few days and the last two he was at a&e.
The nappy rash I just thought either the nappies, etc, you know normal things.

Just that first doctor I can't believe. Think the second has read over the notes and had an oh sh** moment.

He is a bit constipated today so I've been having to rub his tummy etc. His poos "look" the same but they're not as watery and don't smell as bad. His bum is looking a bit better it isn't as hard and raw looking. He will be getting a bath at dinner time to start afresh the cream. He's still farting like mad and they stink.

I will just have to persevere over the next weeks but if he hasn't adjusted then I'll have to speak to the GP about a formula that doesn't have any cows milk in it at all since he'll have that ladder.

We were told this also by multiple people, sudocrem dries out the skin

He is a bit constipated already.
We haven't got a milk thickener but have noticed the bottle needs a good shake occasionally.
I don't think he's got reflux but he does have hiccups occasionally and it's really hard to burp him. I've started using infacol but it's still difficult.
He doesn't like the taste but he can be greedy so will just eat it but does complain through out.
Would you recommend speaking to the GP about a milk thickener?

I wouldn't just try unless there was more obvious reflux signs. If he's still guzzling it down or the hiccups get more frequent or any other reflux niggles over the next week maybe then consider it. Hiccups were a reflux sign in my daughter but they are also very normal too. You don't necessarily need to speak to the doctor. Gaviscon is prescription only for under 1s but you can buy other thickeners to try. Carobel would probably be the most common one. Especially with the constipation I would hold off doing it now and when you start I would only do a bottle a day to start with just to see if that takes the edge of it.

Also it's difficult to do in the first days but if you suspect the feeding is reflux related reduce the feed volumes and that will help reduce the reflux and normalise the volume they are taking. At 13 months my daughter had a reflux flare up and went from having 4-8oz overnight in 1-2 bottles to 20+ and desperate for more. The more milk she had the worse she got. We rationed her to 2 bottles and got her back fine to a sensible amount. With a newborn I would limit the volume rather than the number of bottles. You might find that more frequent lower volume bottles are tolerated better. 5 4oz bottles rather than 4 5oz bottles for example.

Hey @CloeAndJac was thinking of you and wondering how you and little ds are getting on now?
Hoping the new milk is helping his tummy and his bum is finally starting to heal
X

Well done with where you have got to so far! Personally I would try to stick with what you are doing for a week unless any extreme reaction before changing anything at all, so you can give it time to settle. I went through it with the CMPA and sometimes would try extra things at the start (e.g. thickening) because I wanted it all better so quick - but then get lost as to what was causing/fixing what. Thickener for mine meant that if he threw up (and he had GERD as well as CMPA) it was so much thicker and lumpy which panicked me from a chocking perspective so be cautious in approach - and for me I would wait out a week at least with the new milk and treating bum - you might find it all settles by then and you know where you are - or if it doesn't then at least you know the original 'milk' has left the system and you can begin treating what you may have from the new milk. For now you may just continue for a little while still having some system symptoms from the cow milk allergy until it finally fully leaves system

Good luck!

Hiya,
He's unfortunately went from one extreme to the other from explosive diarrhea to constipation. Because it was so sudden he's had to take lactulose. I spent hours massaging his tummy, doing bicycle legs, baby massage to no avail. He was constantly straining to try and poo sometimes waking himself up every 15 minutes. He was still wanting his feeds and not puking but it got to the point the last bottle before the lactulose he puked up, I assume it had no where else to go. The lactulose worked in a matter of a few hours thank god but never cleared it all. I have only gave him 5ml yesterday in 30ml water and 2.5ml in 15 today as his stomach is still brick hard. But he's done a few poos. They are a less watery and pungent version of his previous but I'd say still not the way his poos should be.
I have spoken to the health visitor who told me to prescribe lactulose, and with his feeding plan, symptoms, the fact he looks to have it since birth, she's aware it might end up being an allergy instead of intolerance and instead of waiting 4 weeks on his ladder we are giving it 2. To let his bowl settle then to check his poos and if they aren't what they're supposed to be then it'll be down the allergy route.
He'll then be given a dietician and allergy tested when he's old enough for the test.
Even if it doesn't get to that stage and was just intolerance, I told her after 4 weeks he isn't coming off it, I want him to stay on it to give him a break for a while as he's been through the wringer.

His bum is clearing up really well with that cream. So at least there's that. Still got a ways to go with him.

Intolerance isn't used with babies any more it's immediate or delayed allergies. Immediate allergies cause rashes and swelling and in the worst cases anaphylaxis. Delayed allergies cause gastric symptoms such as diarrhoea, reflux, vomiting and constipation. It looks like you would fit into this category

I'm not sure what you mean by the ladder. Are you talking about the milk ladder? This isn't used until the baby has been off dairy for 6 months or is over 1 and slowly increases the amount of dairy in their diet starting with a tiny bit of a biscuit which has a small amount of dairy that is broken down through the cooking method

I wouldn't worry about having it give lactulose. My daughter was in it for about 2-3 months due to having to have gaviscon and her poos went to rabbit pellets that she couldn't pass on her own. Our HV gave us a colic relief massage that was also good for wind and constipation. Three times a day we did 3 sets of this - water wheel a to the count of 6 crunch legs into tummy for count of 6. Then 6 sun and moon followed by 6 crunch legs. Cuddles then repeat twice more.

They way they are looking at it is the are giving him aptimel pepti 1 to see if he settles on this but if he is still showing signs they will be putting him on a soy milk.
The health visitor said that symptoms of milk tolerance tend to show up around 3-4 weeks old, they progress.
But with my son looking at what he's been like since birth, they are thinking he's been like that since birth.
I think it's because he's been through so much at such a young age they are making a point to try and settle him for a while as quickly as possible to give his gut and stomach etc a break. If he doesn't settle on this milk and it's still irritating him I don't think they want to carry that on so will do soy milk. They can look at weaning him off further down the line after he's had a break. If that makes sense as they generally want to get kids out if intolerances by the time they're 5, unless it's an allergy which they can test for by then. So he still has plenty of time.

Poor little glad, glad he’s a bit less sore. When my DC were in nappies I used to gently dry their bum with a warm hairdryer (at a safe distance, of course) and it seemed to really help make sure all the folds and creases got properly dry. They also seemed to love the white noise!

I don't like disagreeing with professionals but get another opinion because I think some of this is wrong.

For one soya formula is inappropriate for babies with cmpa. Half of babies with dairy allergies are also allergic to soya and the prescription milks are preferred to soya milks. If he doesn't get on with pepti he needs a different extensively hydrolysed formula or an amino acid formula. There are two proteins in dairy whey and caesin some of the formulas have the whey broken down and others have the caesin. You can be allergic to either or both of the proteins so usually they get you to try one that breaks down caesin and one that the whey broken down before they give an amino acid formula

The difference between allergy and intolerance is not when it starts but volume that triggers a reaction. My daughter has delayed allergies that cause loose stools they are allergies because even teeny tiny amounts cause a reaction. She had a wheat intolerance too and this was an intolerance because it only occured with large volumes of wheat/gluten

As you might be starting to understand there is a lot of patchy information about infant allergies with medical professionals. It doesn't actually form part of the compulsory GP programme so you are often relying of GPs with experiences or an interest. My daughters gp didn't know the difference between lactose intolerance and cmpa which are very different especially for breastfed babies who get very poorly with lactose intolerance. She told me my baby would be in hospital if she was reacting to my milk. We did find a helpful GP but after every piece of advice she added the caveat "this is from my experience as a mum to an allergy baby not from my medical training" which I think says a lot!

Also only immediate allergies can be tested for delayed can't and often tests for babies and young children with immediate reactions give false negatives and it can take a few years for them to show up on tests and food and symptom diaries trump tests. For delayed reactions the only way to test for them is controlled removal and reintroductions to see if the symptoms return

I don't know what to do then at this stage.
It was the health visitor that originally said his nappy rash looked thrushy and to stop using metanium and instead use the prescribed cream and vaseline.
When I went to a&e the second helpful doctor said it wasn't thrush. To stop using that cream and the vaseline and to lather his bum in metanium which is clearing it up. He also suspected milk allergy so prescribed the pepti 1.
I phoned the GP because I couldn't get in touch with the health visitor for 2 days about his constipation. The nurse said to speak to the health visitor and also said it sounds like he's colicky. I said he's not because he isn't crying for no reason. He is crying because he's constantly straining to poo and can't and even then he only done little cries as he's a very quiet baby except when he wants fed.
I spoke to the health visitor who said to get him lactulose. I specifically asked the gp surgery to put instructions on how much water to mix it with on his prescription, they never, the label was useless for newborns so I had to guess.
I discussed his milk with the health visitor and she said that originally when she saw his bum she suspected milk intolerance but because I looked so tired she didn't want to stress me out further. While at the same time saying it looked like thrush. She was the one who said if he doesn't settle on apti 1 sooner than the 4 weeks they'll have to look at the next stage and mentioned soy milk.

I'm at a complete loss now because I've been told so many different and conflicting things from so many different people and the only person who helped was the doctor at a&e.

In hindsight this has been going on since birth because he had his nappy rash during the first midwife visit.
I haven't noticed the progression of the diarrhea until like 1 day before a&e when 2 specific poos were horrific because his poo went through so many changes.
I don't want to sound awful but this is extremely stressing me out and if even he was older it might not have as much but because he's less than a month old I'm scared incase this all permanently damaged his gut system as it hasn't had time to "set up properly". Or that there might actually be a problem somewhere.

He's a content wee thing and he's hardly complained except when his bum was red raw and when he was struggling to poo or is "starving" after waking himself up but that's his normal routine.

Bless you. So hard. I'm afraid you have been getting the run around by some medical professionals. The lack of knowledge of gps and health visitors about infant allergy is shocking. The info you have been given by @Superscientist is correct. If the extensively hydrolysed formula isn't right, then you would move onto an amino acid formula. Absolutely not soya or goat. The proteins are too similar. The only test for delayed allergies like this is, if symptoms improve, to reintroduce the cows milk formula and if symptoms return you have a diagnosis. The best people to see are paediatric allergy dietitians. Ask if the gp can make a referral or go private. There is also excellent up to date cmpa information on Instagram from accounts run by paediatric allergy dietitians. They often run courses on how to approach/manage it. Check out www.instagram.com/childrensdietitian?igsh=MTJ0MGh0bDZ5b3ZuNg==

My daughter was 17 weeks before we started on the allergy free diet and was about 14 months before we were completely symptom free as she has a lot of food allergies and honestly you would never know. We haven't been able to reintroduce any foods but at nearly 4 years are well practice and she has a great diet all things considered. There's been no lasting effects.