Rotavirus

Ah, the week of the stomach flu… I have just gone through one, so I am thinking about it. It’s my fourth time in five years, so that means almost each year it hits. I hate this week. I hate it every time it comes. But since it is largely the same, I thought I’d post about it just in case it helps someone.

Rotavirus is the most common cause of a week or two of family “stomach flu.” It is very common with babies and young children, and despite what the websites tell you, it usually passes on to the adults in the house! I don’t know why they say adults usually don’t get it, or as severely, because that’s not true. The bigger the adult, usually the more violent it is.

Anyway, rotavirus usually starts very suddenly with your child fine and eating, and then randomly after some meal, just vomiting everything up. Sometimes several times. If you try and give them Pedialyte, they will most likely vomit that up too. So despite what the websites say, save your money and don’t try that right away. Wait a day or two. The vomiting may last for awhile, it depends on the child. Usually the child will vomit until the stomach is all the way empty, and will stop once it is. If you give them cheerios or whatever the next mealtime, or liquids too soon, they probably will vomit that too. In my limited experience, it has usually taken 24 hours for my little children to hold anything in their stomachs. Sometimes closer to 48.  And usually it is only a graham cracker or something very small. Once they can hold it down, they are usually crampy and don’t have much appetite anyway for awhile… cheerios or saltines are as ambitious as they get.

The other main symptom of rotavirus is diarrhea. And it is nasty–explosive, watery, smelly. I could always tell when my child’s diarrhea was stomach virus versus something else because it was so pungent. Sometimes my child got diarrhea right away with the first vomiting. Danger on both ends! A plastic high chair is a good place for a young child to be at these times because it is easy to clean up. Other times, the diarrhea follows after the vomiting stage is over, like 24-48 hrs later. The child might even be hungry and eating, but the diarrhea continues… usually directly after eating, and sometimes several bouts quickly before it stops. In my toddlers, they were usually fine when they weren’t eating, and I could put them down for a nap in between meals without worrying they’d mess the crib. But the sad thing is that the diarrhea can last a long time, even 7 days or more. In these cases, you really have a situation because the child might be back to “normal” but you have to watch them like a hawk for those bowel movements… they can really make a mess. Be prepared to have a lot of bleach, pairs of pants (jeans are the best), and a lot of laundry on hand for awhile. (And a face mask, for you!) As bad as it is, it is easier to deal with toddlers in diapers than preschoolers in underwear. You may want to consider putting a preschooler back in diapers or disposable swimmies, just for this situation. It’s embarrassing for them, but most preschoolers have trouble making it to the toilet in time, every time, when it comes quickly or often.  You can have them wear plastic pants over their undies, but the elastic around the legs often makes it hard and messy to get off. Definitely avoid socks and sneakers if you can, since they will get messed. Stick with bare feet and plastic shoes like Crocs or sandals.

The main risk of Rotavirus is dehydration, and it is not totally uncommon for children or adults to have to go to the hospital for a rehydrating IV. Definitely if the patient cannot keep water down for more than a day, or passes out from the vomiting, you should take them to the ER so they can IV and monitor. But it is not uncommon to vomit seemingly forever, even turning pretty white, and just have to stick it out in your own bathroom until you can keep fluids down. If you have an infant, keep feeding and give Pedialyte in small doses (1 tsp) regularly after the vomiting stops. Some websites recommend soy formula rather than lactose-based for the recovery (because of the protein and easier digestion), although some infants can’t tolerate the soy even when they’re healthy!

The good news is, the worst of the rotavirus usually is over in 48 hrs–per person.  But by then it has usually passed on to someone else!  Then the 48 hrs begins for them.  Usually the major vomiting stops within that time period, but don’t make the mistake of drinking/feeding too much, too early. Go slow or the vomiting can return and you’re back to step 1.  Websites will say to offer food 6hrs after vomiting has stopped, but I find that is too early.  Websites say not to stick to the BRAT diet necessarily, but I find that to be misleading… toast and crackers really are the first foods for an upset system, and I wouldn’t venture beyond that until those are happily digested.  And websites today often say milk products are not as bad as people thought. But I have found (through experience) to stay away from dairy products for a week or more. .. until the diarrhea is gone.  Stay on carbs, but make sure they are always getting enough water and Gatorade. Small doses throughout the day. Gatorade is dissed by experts, and so is water, for not having the right balance of salts.  But I find that diluted juice aggravates my kids’ diarrhea whereas the sports drinks (watered down too) didn’t.  I guess you should experiment for yourself.

The morale will probably come back to your child before all the symptoms abate, like 2 to 4 days later. Very low morale is a sign of dehydration, so supervise carefully in this stage, and watch for dry lips and eyes.   One of my preschoolers stayed in bed for five days this past week, but my kindergartner was hopping around only two days later!  So everyone is different =)  Don’t take anyone to a playdate or nursery once their morale is back because rotavirus is extremely contagious. It usually appears about 24-48 hours after first contact, and it is contagious for 3 days following inception. If the child’s underwear or diaper leaks during the playdate, just even a tiny amount of stool can infect the other children… rotavirus in the stool lives for up to 4 weeks. Make sure you follow the child everywhere with bleach because that is the only thing that will kill it. We use hand sanitizers, disinfecting spray, and Clorox wipes in the house, but bleach is the only thing that is documented as true killer. So that’s your best friend while the secretions are flowing.

Obviously wash everyone’s hands as much as possible.

But the SADDEST part about rotavirus is that you can’t get immune to it.  You can get it again.  I don’t know if this is because there are multiple variations of rotavirus out there, but it is not uncommon for some families to get the bug a couple times within the same season.  It is more common in the wintertime, and I believe there are some charts out there about the geographical spread of the virus–Southwest USA getting the most cases in Nov/Dec, Midwest peaking in Jan/Feb, and Northeast by Mar/Apr.  Of course these are just approximations, but I do believe epidemiologists have noticed trends.  So super-clean your whole house after everyone’s well (especially bathrooms) and be vigilant about spreading in your local area.  Hibernate for awhile, especially from nurseries and public transportation, if you notice people dropping like flies =)  It will pay off, even if you’re bored for awhile, to not get it again.

Coping strategies I came across this week (and we’re not done yet!) are…

1. For the vomiting stage, make sure the child’s bed has a waterproof cover on the mattress and on the pillow. Strip the sheets and lay a towel on there instead. When they throw up in the bed, you can just pull off the towel and pillowcase, wipe down the waterproof covers, and put a new towel and pillowcase back down. This is MUCH, MUCH better than cleaning continuous vomity sheets, blankets, etc.

You can also put a towel on the floor right by the child’s bed, if you are worried about carpets. Pull beds away from the walls if possible because it is hard to clean vomity walls/cracks.

2. For the diarrhea stage, give your kids a Pepto-Bismol before naps and bedtimes. The doctors will tell you not to, but it is terrible to have diarrhea while sleeping if you can avoid it. Especially if you have a baby because they might lay in it all night or get it in their mouths. It is worth taking a little Pepto (or Immodium, as I used on some of my kids this week) to keep sanity. Anti-diarrheals don’t always prevent diarrhea in this situation, but they can at least decrease the amount.

3. For any stage that is still messy, fill up your washer to soak with hot water, bleach, and laundry detergent. Then you can throw messy pants or linens in there throughout the day as they accumulate, and run when it gets full. Bleach will not take the color out of most kids’ clothing unless it is poured directly on the fabric, so it is a safe place to store messy clothing for a couple hours throughout the day.

Throw away any clothing that is too soiled to clean, or hose it down in the yard or laundry tub before soaking. Make sure you resanitize the laundry tub with bleach afterwards.

4. Try to keep little children who are still messing in areas without carpets. Put little babies in Pack N Plays, which are plastic and easier to clean. My three year old took a nap on the Pack N Play mattress, on the kitchen floor, with a blanket on top during his vomiting day. Much easier to clean than sheets and bedroom carpets. During the diarrhea stage, if children are playing on couches or carpets, or you have to take them in the carseat, have them take a plastic placemat with them to put under their bum so they don’t have accidents on the fabric. Portable seat cushion! Totally worth the reminders to take it everywhere.

5. You can teach older kids to vomit in a bucket or bowl, but most little kids can’t do this. Try keeping them in the bathroom or bathtub, or in the kitchen, or in their plastic-covered beds while things are bad. Definitely keep extra buckets or plastic trash cans in rooms and bathrooms. There are times when mess is coming out both ends, or by total surprise, that you need extra bins around!

6. Assuming they can keep at least water down, don’t worry how long it takes for your child’s appetite to return. Hold back kids who think they’re ok and want to wolf things down just because they’re not throwing up anymore. And let a child who is reluctant to eat be reluctant… they’ll eat when they are ready. Watch the pallor of the face, and the hydration most (lips, eyes, mouth, tears), and as long as it’s ok, it’s no big deal if they don’t eat for a week. They’ll be tired, but no need to fear that fasting–even for a toddler–is the end of the world. It is only a big deal for an infant, who cannot be allowed to fast. For the infant, keep nursing or bottle-feeding even though they can’t keep much in there, and consult your doctor as often as needed.

7. Do not rely on Rota-Teq, the vaccine. My two-year old had that last year and she was still sick this year.

Boys and their Bowels

Ahh, boys and their bowels. A lovely topic. But it must be discussed =) I have had three boys and even though they have wildly different personalities, some commonalities have emerged:

1. Somewhere around 2, the boys started hated having their bowels. They really resisted it and would generally hold them in forever. My mother-in-law called this “anal-retentive.” But whatever it was, they would whine, cry, or sometimes hide off and on for days whenever they felt the urge to hold it in. This led to the second commonality…

2. When they would go, their bowels were huge. When they started getting them in the toilet, my husband and I would marvel over how so much stuff could fit inside the bellies of such little people. The boys themselves started to get proud of their big bowels and would happily describe them to us as “big,” “huge,” or “giant.” It was kind of disgusting, but to them it was just functional, something they had created. And big they were! Many of them stopped up the toilet and we had to keep the plunger right on hand.

3. In general, they always seemed constipated. Probably due to the massive “holding it in” problem, they generally seemed backed up or even slightly pained as they passed their bowels. They had plenty of fruit and water in their diets, but it didn’t seem to matter. As babies, the number of times our boys pooped was always a worry. And it didn’t change much as they grew! Until we let it go 😉

Giving our kids snacks on the toilet helped them learn to poop on it. Giving them M&Ms as a reward for doing their duty helped motivate them the next time. Laying a piece of toilet paper across the seat (under their bum) helped them feel “covered” while they were working on it. And doing the wiping for them until they were older and more coordinated (around 4, 4.5yrs) all helped the bowel training process.

But basically I learned through toilet training three boys that boys having bowels is just a big deal for awhile! It’s totally normal! They didn’t like going, they didn’t like a dirty diaper, and they didn’t like sitting there on the toilet and letting their bowels drop, and they didn’t go very often if they could help it. Doctors can recommend diet and suppositories, but who wants to do that? Nature will eventually take its course. The reality is that many little boys are just this way and until they are five and have some perspective on the subject (and are more skilled with toileting themselves), their bowels are like an event. In some way, it is not totally unlike my husband or my father who stereotypically head off to the toilet with a newspaper or magazine for quite some time! It is always a source of slight dread for them and when they finally emerge it is like the world is a brighter place. I have never really understood this about men, but apparently it is just one of those gender mysteries that start from the beginning =)

The point is, don’t stress over boys and their bowels. It’s not worth it. And if you really have a constipation problem that is needing intervention, give them some juice and put them in a warm bath for awhile. It works every time =)

Croup

I know hardly anyone uses this term anymore—there’s several fancier names out there—but croup is when your child doesn’t feel well and has this signature “barking” cough that sounds like a dog or a seal.  Sometimes there is a fever and sometimes my babies used to get this after spending time in the nursery in Sunday School where others were sick.  They’d go in fine and within an hour of leaving, they’d start this cough which was so scary sounding, like an animal instead of a baby. 

In most cases, croup is not life-threatening and it goes away on its own.  You can call your doctor if you’re worried, but they will probably give you advice over the phone unless there are other concerning symptoms. 

Here’s how we treat croup in our house.  Put the baby in clean sheets and light pajamas.  Give them fever reducer if necessary.  Put a humidifier or vaporizer on a surface near their crib so that the air is not directed towards their face but it is around their height.  (You don’t want the air to go into a wall or other surface but into the air that is near them.  You also don’t want the air to point directly into them because it can be hot or overly wet.)  Make sure the baby can’t reach or knock the humidifier over, either—but do make it as close to the crib as is safe.  You want them to have moist, warm air circulating around them which will relax the bronchial passages when they cough and help them breathe better.  Don’t forget to close the door and draw the curtains so the air will stay in there, incubating them.  They will probably get wet or sweaty, which is why you have them in light pajamas.  Try not to use blankets or other things on them that would oveheat them or soak up the moisture.  I used to go in and change them half way through the night if necessary, and mop their little heads.  

Other than that treatment, try to keep them isolated from other kids (for their sakes, mainly) as soon as you hear the first weird coughs.  Nurse them a lot or supplement them with fluids, and keep them still and in bed as much as possible.  If you can gain good ground in 24hours, you will have beaten the worst.  If not, croup can get more dangerous or difficult to defeat.   But don’t worry too much about them or the cough; it sounds painful and much worse than it actually is.  I have to remind myself of this each time because it is unnatural—but on the whole, if I get to the treatment quickly, they get through it better than other colds. 

Call the doctor immediately if the fever gets too high, the breathing becomes labored (chest heaving or sucking in), vomiting or other strange symptoms come in.  (Vomiting once is not a problem, and may be a sign that their body is fighting something off and just doesn’t want food.)

Toddler Tummy

“Toddler Tummy” is what they call diarrhea caused by too much juice.  Nowadays juice is getting a bad rap, so this phenomenon is not quite as popular.  But just a few years ago, everyone offered babies juice —even to my six month old!  I thought this was crazy at the time, and it has taken almost five years for that trend to stop, thankfully.

Still, any kids activity you take your toddler to will probably have juice for them.  And sometimes it is diluted, sometimes not.  Some parents I know even allow their one or two year old to carry around a cup like a security blanket all day, sipping on it whenever they feel the urge.  This is prime reason for Toddler Tummy.

A cup of juice is not as harmless as it looks.  Besides the sugar and empty calories (which most people admit is bad or at least unnecessary for a small child), it is very acidic.  A lot of toddlers who down a cup of juice—especially if it is full-strength—will simply urp it up.  This is because it doesn’t sit in the stomach well.  When they drink it too fast, or they drink and then start playing (with lots of bending and normal toddler body movement), they’ll end up spitting up a part of it back on your carpet.  It’s harmless but annoying, caused by the acid.  Sipping slowly throughout the day will not cause urping, but it is bad for the teeth and can cause other problems…

Juice also fills up the stomach so that the child doesn’t feel hungry and won’t eat.  Most toddlers are notoriously picky eaters, so a diet that includes juice (or milk) doesn’t help.  Put a plate of food and Hawaiian punch down in front of them and watch them grab the juice.  They drink some and then don’t want any food.  You have to fight and fight them, worrying about them for days, but you don’t realize that juice and milk are filling up their little tummy, fueling the problem.  They might even have bowel movements so you think they’re ok, but they’re not.  Their bowel movements are because milk is a solid drink (i.e. not water-based, not hydrating, so it is processed similar to food) and juice’s acid/sugar can cause irritable bowels.  The moment you put them on water only, you should see at least SOME improvement in this department.

Orange juice is even stronger and often gives toddlers an allergic reaction, resulting in recurring bouts of diarrhea until it passes through, sometimes with a little blood or a skin rash.   I’d hold off on orange juice until at least two years old, maybe even three or four.

But even regular apple or Juicy Juice can cause diarrhea if a toddler drinks too much… more than four ounces, for most little toddlers.  My almost five year old gets diarrhea still if he has more than seven or eight ounces (more than a normal kiddie cup).  So if your otherwise healthy toddler/preschooler ends up with a crop of loose bowels and you can’t figure out where it came from, I’d look first at what they’ve drank that day.  Toddlers simply don’t need juice, even though they like it, so dilute it to 50-50 when possible and never serve more than one cup full-strength or two cups 50-50.

Now I am not a juice Nazi, and I don’t believe it should be stricken from the record.  It has its place.  But if you are having Toddler Tummy or pickiness problems, consider the cup as the culprit.

The Common Cold

Whoever says a “cold” isn’t caused by the cold obviously doesn’t have children. Whenever autumn comes, and especially if the temperature is see-sawing up and down, be prepared for your child to get their first cold. Especially if they forget their jacket and you see them with that signature Rudolph nose. The sniffling and coughing is probably coming within 24 hours. Same with spending time in a playgroup like the library or Sunday School. When other kids have colds around them, they’ll probably pick something up within 72 hours. (Not to be grim, it’s just true!)

Fortunately, if what they contract is just a cold, little children can make a rapid turn-around if you jump on it. They don’t have to get to that moany, listless, feverish stage. Most people know the common cold is actually caused by a virus which is why you can’t kill it with medicine, and why you don’t get immune. Furthermore, there are over 100 viruses that cause cold symptoms so even if you could get immune to one, you’d probably just pick up a different one. The AAP says that the average child picks up 8 to 9 colds a year, and my pediatrician says it is not uncommon (here in our freezing city) to feel like your child was sick all winter. They probably weren’t, but they picked up 3 or 4 different viruses in succession which appeared the same. When you combine that with the ability of a toddler’s nose to run forever, you think they’re always sick. But they really needn’t be “sick, sick” if you act.

The first sign of a cold in one of our kids, and I immediately give them a bath, change their sheets, add an extra vitamin, and eliminate sugar and milk from their diet. Sugar compromises the immune system (unnatural sugar, that is), and milk is a mucus-producing agent. The nose and chest will get better if they stay on water until their running nose and cough heals. I give them lots of water (or Gatorade) in small bits throughout the day, and I add at least one extra nap (for less time if necessary). Usually their appetite drops, so that works with me. And I try to keep them warm and still as much as possible for 24-48 hours (a sweater, socks, television/videos, puzzles, whatever). If I do this, the child normally turns around with just a clear runny nose and maybe a dry cough at night to knock.

You can’t really keep your house germ-free with little children because they cough and sneeze a lot, get their runny nose on your clothes, and put their little hands everywhere. Plus, you are the mom and staying with them, loving them, cleaning them is your job. But making some attempt to clean house (especially knobs, phones, keyboards/mouse, and toys) with bleach wipes or Lysol spray is probably wise. Also washing your hands a lot and/or using sanitizer. But remember, viruses aren’t bacterial, so the best preventative measure is normal and regular washing, keeping your hands away from your eyes/nose/mouth, and keeping your immune system healthy with a good diet. Try and do this with everyone in your house while someone is sick, and you should reap at least a little better situation than if you did nothing.

Also, turn up the heat if necessary. While most Americans are energy- or money-wise in the winter and try to keep the thermostat down at night, the cold is not going to help anyone get well once they are sick. It will only prolong it, especially a cough. In the same way that the immune system is compromised initially to contract a cold, it can stay compromised when trying to fight it off if the temperature is too low. I’m not saying to make your house a sauna, but there is a reason why all the elderly flock to Florida and why Boston and Chicago hospitals are overfull during the winter! (My nurse friend actually only gets one holiday out of Thanksgiving, Christmas, and New Years because our hospitals are so overworked, but she gets random time off in the summer when admission is so low they don’t need her). I think the cold constricts nasal passages and blood vessels, which has something to do with it. Warm temperatures causes good blood circulation and better release of toxins, which is why they have saunas at spas and massage parlors. So keep the bedrooms warm and humid, and you’ll probably gain at least a day or two of progress.

Just FYI, little babies and toddlers can get fevers when they’re getting sick, and you should give them Tylenol (acetaminophen) to reduce it if it is over 100 or if it seems like they might have pain. Under 100 is not as dangerous to the child and may actually help you contain them since they won’t feel like running around—use your own judgment. (Fevers also reduce the appetite and may cause vomiting if you force a child to eat, even something benign like Cheerios.) With the children’s medicine issue these days, I’d say Tylenol is still pretty safe and usual to give if your little one is suffering. But I’d probably stay away from more powerful cold medicines with dextromethorphan or phenylephrine/pseudoephedrine if my baby was young.

Vasectomy

Ok, girls. Here’s some man talk for you. Warning: don’t read if you’re skittish about male parts.

So let’s say you are done having children and want to know what is involved in your husband getting a vasectomy. It certainly isn’t the most talked about subject in the world, even compared to female anatomy.

Getting a vasectomy is actually pretty simple and, comparatively, not a big deal. Certainly not as big a deal as labor/delivery or getting your own tubes tied. However, it is a bigger deal than a routine gynecology visit, and you can’t forget that most men are not nearly as used to medical situations concerning their private parts as women are. So don’t be surprised for some squeamish talks and responses.

So here’s the deal:

A vasectomy is a small in-procedure operation that takes about 20 minutes in a urologist’s office. Many urologists have their own clinics so you don’t have to go to the hospital, and your husband can even drive himself home. The procedure includes washing and shaving the scrotum, local anesthetic, a small incision made in the upper scrotal area (under the penis/above the testicles), and the subsequent cutting and cauterizing (yes, burning) of the vas deferens tubes. It is uncomfortable and awkward but shouldn’t hurt… the nurse will gauge your husband’s reactions and the doctor will administer more local anesthetic willingly if necessary. Then your husband gets a couple dissolving stitches and some bandaging around the area, and is asked to wear snug briefs for a week while the wound heals. Usually a mild prescription painkiller is prescribed for a couple days, and you can expect your husband to limp around with an ice pack for a day or two. No shower for 24 hours so do it beforehand, but the bandage can come off on the second day for a shower. He is asked to mostly sit/lay down for 72 hours (no working, so do it near the weekend), and then it can take about 6-9 days to recover completely but at least he can walk around.

No intercourse for a week (don’t worry–he won’t ask anyway) and then a follow up visit to drop off a fresh semen sample after 15-20 ejaculations to make sure he’s infertile. He can just bring the sample to a lab and leave–no loitering required. After 5 weeks or 15 ejaculations, many men’s sperm count has dropped enough to be effectively infertile. Sometimes it takes a little longer. But most men don’t want to go anywhere near Mr. Snippies after the operation (nor do they want to do their special thing in a cup) and want to skip the lab test completely. That is completely understandable—I hate even peeing in a cup—but technically the doctors ask for two samples to be textbook sure. It’s fine to skip but just be warned that you should continue birth control until about two months if you’re afraid of getting pregnant. It’s annoying but then you’re infertile for the rest of your life, so you can handle waiting a little longer!

My husband said the worst part was the cauterizing. Not because it hurt but because you can’t stand to see smoke or smell burning coming from down there! He also said it made him feel a little faint when the doctor was getting to the exact right place to snip. But largely, while it wasn’t fun, he got through it. It probably ranks up there with root canals: you would never recommend the procedure for fun, but you can get through it when you need to.

As the wife who is probably stuck handling all the technical details, here’s what you need to know:

Find a urologist you want to use, and one that’s in your network if you have an HMO. Call them up and schedule a consultation for your husband. The consultation is a brief visit where the urologist checks your husband’s parts out and explains the process entailed.

Call your PCP and tell them the urologist you want to use/time of consultation visit. They’ll need to submit a referral to your insurance if you have an HMO. Most PCPs do not require an actual visit because that’s what the consultation is for.

Your husband goes to the consultation with the urologist. It doesn’t last long but they do examine the private parts to make sure they are ok. This means your husband has to undress from the waist down and wear a sheet, like you do when you go to the gynecologist. Then the urologist will give your husband the ok and tell them all about the vasectomy process. Usually there are some reminder/info worksheets to take home, and your husband should schedule the vasectomy before he leaves if you want the soonest appointment possible.  Pay your normal co-pay for doctor visits.
Your husband has the vasectomy.  It should cost your normal co-pay too. Insurance should handle the rest!

He’ll be bruised up and worried about his parts probably, but don’t worry.  It will heal and life will go along normally after a week or two.  He shouldn’t have real pain.  It might look ugly for awhile though.  Once everything heals, you can go back to sex life whenever he’s ready.  He might be tender the first two times, but not as bad as you recovering from labor/delivery.  After that, things go back to normal.  VASECTOMIES DO NOT IMPAIR SEXUAL FUNCTION.  It should not change one thing about his performance or feel.  The only difference is that his little swimmies are no longer there to begin life again.  There may be some grieving on one or both of your parts about this, or feelings of loss of masculinity/femininity, so be prepared to work through this if so.  But as long as you consider this carefully before you get the procedure done, you should be up and raring to go, like your normal selves in about two weeks.

Diaper Rash

Diaper rash is normally caused by irritations or allergies. When it is caused by irritations, it is usually because the diaper has been on too long or the urine/stool is especially acidic. Sometimes oranges, raisins, peanuts, candy, or other foods cause irritations because they are not digested well and large pieces survive in the stool. Or a harmless diaper that has been on all night, too tightly lodged in pants, or sat on for too long can cause diaper rash.

In other cases, the baby is actually allergic to a food or liquid ingested. They may have seemed fine upon eating/drinking, but as it moves through the bowels, it causes a problem. Sometimes there is severe cramping while trying to go. Sometimes there is diarrhea. Sometimes there is blood in the stool. (There shouldn’t be a lot, but there can be patches or a general red tinge all over). Sometimes the stool just smells really “off” (like a horse or strangely pungent). But a key sign of allergy is a diaper rash that bleeds when you wipe it. There may be little dots or blemishes on the skin which are extremely sensitive and tender so that the child screams when you wipe them or arches their bum up and away from you. Or they might clench their little buttocks together hard so you can’t wipe in there… all are signs that whatever they ate caused a bad enough reaction that you should take that food/drink out of their diet.

In our children, milk and orange juice were common culprits. If my second-born toddler had any citrus product, he would get this type of thing for several days on end.  It was a hard cycle to get out of because he would have continual loose stools which required lots of wiping, but the wiping caused bleeding and open stings.  In my fourth child, she had this reaction to milk products until she was about fifteen months old.  I have heard of peanuts, wheat, and berries causing this type of reaction too—all highly potential allergens.

This doesn’t mean you can’t try these food again, it just means the little system is currently unable to handle them. Many babies have allergic reactions to peanut butter in the first year, for example, but eventually outgrow it in the second year. The same thing for milk/yogurt. Wait a couple months and try again later (with a SMALL amount, waiting for at least one diaper response.  Take a weaning approach, and be patient.

Allergic reactions can also occur if the child is having a particular food too often.  A child who is not truly allergic to peanut butter or bananas, for example, can develop an allergic reaction with loose stools and tender red rashes if they are eating those foods every day.  As soon as you back off the dosage, they go back to normal.  Varying the kind of peanut butter (almond, cashew), or other offending product, can help prevent allergic reactions.

In these types of cases, take advantage of what I call “pre-emptive diaper rash.” Before it breaks out in bumps or bloody blemishes, the skin sometimes just gets all red like a sunburn. The child exhibits sensitivity to being wiped, but if you can eliminate the offending food/liquid then (or you only served it in small amounts), and lather on some balm, you avoid the full-fledged diaper rash problem that sometimes takes days to heal.  Most zinc-oxide ointments do fine at this stage.

But if the rash is full on, you’ll need a real ointment to keep the area protected in the diaper.  Aquaphor is the best because it is really thick so it prevents irritation from the next urine/bowel.  Try to keep liberal amounts of Aquaphor on the rash itself and after a few successful diapers with no stool in them, you should see some progress.

Use Pampers wipes for Sensitive Skin.  They are dye-free, perfume free, and the softest kind available.  Huggies or generic wipes will be too rough on a delicate rash.

Be aware that super-cleanness is also necessary for the area to heal.  Getting every little spot pristine is difficult if the baby is experiencing lots of loose stools and pain during wiping.  You’re tempted to back off and leave their little parts alone.  But the area must stay entirely clean or parts of their stools will continue to irritate the skin and sting any open places.

Also be aware that open air is one of the best things for them because “hanging loose” keeps fibers from brushing up against and irritating the skin further. Obviously you can’t just let your baby go diaper-free for very long unless you have grass instead of carpet! But it does speed the healing, so try it for awhile on a towel, in the bathroom, or on the lawn if you live in a warm climate. Or you can try a disposable diaper loosely pinned instead. I used to let my older toddler go around with no diaper but sweatpants on for an hour since I knew he could avoid peeing for short amounts of time.

The last ingredient to healing is dryness. Change the diaper often and try to keep the area as dry as possible. Avoid strenuous wiping, or skip the wiping whenever possible.  Use a “dabbing” motion when wiping instead of the usual “swiping” gesture, and pat the bum dry with a tissue or toilet paper.  Bathe normally to keep the area really clean or soothe, but don’t bathe to heal the rash specifically–it doesn’t work.  Baking soda can help the sting if you suspect it, but after baths, make sure you get all the little skin folds dry so irritated areas don’t chafe or breed bacteria.