Diaper Rash???

[Big Hearts]

One of my dcg showed up today with such a bad rash she is bleeding. The dad dropped her off and said she has a bit of a diaper rash and gave me extra diapers and zinc cream. (Side note I think is relevant she was gone for a week to Toronto from Winnipeg MB on a road trip. I think she was sitting in a dirty diaper the whole way home.) She has been with me four months now and once w week gets a rash for a day or two. My question is how do you tell the parents to see a doctor? I feel bad telling parents how to care for their child but this is bad...if she is bleeding and uncomfortable then what should I do? Is this normal? I have children of my own and never have they been this bad. I feel so bad for this little girl.:no:

[Inspired by Reggio]

I would just explain 'While it is normal for children to get diaper rashs on occasion ~ I am concerned about the frequency and severity of the ones she gets and would just wondering if you could get her into the Dr for confirmation that the rash is not something else at the root such as an allergy to something or a contagious/viral thing she is working though'.

You could if truly concerned ask for a 'reentry form' that states clearly from the Dr the rash is not 'contagious' and poses no risk to any other child in care?

[mamabear]

I have a family with a lil one like this. It breaks my heart every time I change her diaper :crying: When I justbring it up with dcmom she jus says oh, she's going through another teething cycle. Whatever that means. Or she'll say, yeah, her urine is really acidic right now. I don't get that one either. Sooo, I just change her more often and always use zinc and vaseline. Funny though how it's always worse on Monday's when she's been home for 2 days.

[Momof4]

I have a friend who has a child like that in her daycare and she always feels so bad for the little girl. It's pretty normal for them and they are trying different creams to find one that works better.

I had a little boy in my daycare with very sensitive skin and his parents finally went to the doctor and gota prescription for a strong medicated cream and he cleared up. Maybe you could suggest that to the parents?

[Mamma_Mia]

My SIL used Denestin (available at shoppers) and it worked wonders on my nephew. Everything else was working but not very well. He had a bad rash for over 2 weeks and with using the denestin it took 2 days for it to be all gone!

Also one of my fellow dcp swears by Burnt Flour. You litterally in a clean frying pan stir around some flour until it gets a brown colour and use a salt shaker. apply at every diaper change.

[Sandbox Sally]

Poor little girl. That's AWFUL. :crying:

Desitin is zinc oxide, just like the other stuff. It's a little thicker though, so it stays on better for protection. What this little one might need is chlotrimazole, which is an antifungal. You (rather, the baby's parent) can get it over the counter under the brand name Canesten or Lotrimin. It's used also to treat athlete's foot or a yeast infection in women, so if mom can't find it in the baby aisle, tell her to go to the foot care aisle or the feminine care section. :)

[playfelt]

Was going to suggest the same as Alphagetti - clotrimazole works wonders. Using it now on a child in my care. Parents said he is prone to yeast infections and yes he is raw, red, bleeding. This was prescribed by the doctor. You want the one that says it is for athlete's foot, ring worm or jock itch - not the one that says for vaginal yeast infection in a woman because it is external not internal. It won't be in the baby aisle. Also the store brand works just as well for cheaper.

The doctor can also prescribe a similar cream that is basically a mixture of clotrimazole and cortizone but must be used sparingly. There is also something called Butt paste that is fantastic.

[Big Hearts]

Thanks everyone :)

[apples and bananas]

I don't think you ever tell a parent to seek a doctors advise. I think that is crossing the line. However, If the child is not well enough to come to care based on your policies ... that you can tell them.

[crafty]

I just want to say that it may not be just because the parents leave her in diapers for too long. Some children are very very sensitive, I know because mine were. Maybe it was because my husband and I have skin diseases but they would get very severe diaper rash so mush so it would bleed and it would be frequent as well. I would let them sleep completly naked (Boy Have I washed towels and blankets ohmy:)), left them diaperless for hours and hours, had a prescription cream, I always used washcloths to wipe them never wipes, tried different types of diapers, different types of cream, even detergent...it would still get bad before it got better. What did work best for me is a bath in crushed wheat 2 times per day.

[daycaremum]

Yup, seen this many times, it's not about how clean the parents are keeping them. Some pees and poops can be more acidic and if the child has sensitive skin this can easily happen. I also swear by the clotrimazole in the foot aisle, only because it is cheaper than the one in the ladies aisle, not because it is any different (the pharmacist told me this). I recommend it to all my families with babies to have on hand just in case. I do the clotrimazole then a barrier cream (a thick pasty one) and then corn starch (not baby powder as it is not good for your lungs) to soak up moisture. Works like a charm every tim.

[bright sparks]

I don't think you ever tell a parent to seek a doctors advise. I think that is crossing the line. However, If the child is not well enough to come to care based on your policies ... that you can tell them.

I don't think it is crossing the line personally. I think theirs an appropriate way of telling them like politely suggesting they see a dr. Maybe when the diaper rash has been around for a couple of days, make sure you bring it up with them every single day and when its been a week say how you have been monitoring it closely, changing the diaper more frequently and you are not seeing an improvement so something else has to be done. Say to them it is becoming disruptive in the childs day to day activities as it is very uncomfortable. I am not sure how a child would be to unwell to come to daycare because of a diaper rash as its not contagious. Even with an infection it is covered and I would make sure the child didn't touch their bottom so as not to have hand contact with the area If it was SO severe and came to the point that the child was screaming in agony, then IMO thats to the extreme of neglect as the rash would undoubtably be horrific and alarming and obviously so to everyone in contact with the child. If I had not spoken up and told the parents to seek a dr's advice before this point, I would be partly responsible.

On the point of how to deal with this, I worked in nursing for several years and also in the community with the elderly. The majority of clients had bedsores and required wound care, which is essentially the same as caring for diaper rash unless there is an infection. Here are my rules of thumb which have never failed me yet both for children and adults. If the skin is broken, as in open wound and bleeding, whether it is minor or major, I do not use any zinc based creams. It clogs the open areas. It may heal in some cases, but as the new skin has formed over the clogged area, it could be back to being broken as easily and quickly as wiping with a baby wipe. The new skin is fragile, but theres also the cream which causes it to take longer to heal sufficiently. I use vaseline on these areas until the would at least heals over and then I go full force with the zinc cream, the higher % the better. Even if the area isn't open, at naptime I always use vaseline again as the skin is exposed to moisture for longer periods and this provides a nice barrier. When I use vaseline I use copius amounts and put a very thick layer on the area as some will obviously come off with the diaper. It's also very important to thoroughly, but gently pat the area dry before applying anything. If its an open wound, I do not use baby wipes as this can cause irritation and inflamation and I ask parents to supply me with washcloths which I use with luke warm water and then I use a dry one to dry off after.

Some people have more sensitive skin and have a rash on a more regular basis. For them this is normal and it is better to have a more regular and consitant "bottom care routine" than using medicated creams on a regular basis. Even with no rash, my advice would still be to always use some kind of cream or vaseline as a preventative measure. Obviously not all parents do this. When medicated creams are used, the recovery is much quicker but the skin is far more fragile and thinner making it prone to breaking and also high risk for furthur diaper rashes requiring more medication and furthur risk of infection.

If anyone is having a problem with keeping the rash covered in medicated cream long enough for it to work, because obviously the diaper takes a lot of it off almost immediatly, try a product called tegaderm. Its fantastic for so many things. You can buy it from Home Health Care stores which are usually attached to Shoppers Drug Mart. It is a clear protective film. It keeps the cream in place and is painless to apply and painless to remove, I promise.

I don't think doing just one of any of the above is effective. You have to do a combination of things and yes, if the parent isn't on board with this over the weekend then Monday morning will be worse for a daycare provider.

If a daycare parent wants me to give the best possible care to their child, and I put everything into helping the child overcome something like this and they don't, then I have every right to pull the parents on it. When taking a family on and going through my contract, I am quite clear in my expectation of them as they are with me. We work together in caring for their child. If they aren't working with me, then they are breaking their contract and I'm going to say something to them. This is ultimatly their child and their decision on how to raise them, but if they sign and agree to this condition and don't stick with it, then they better bloody well expect to be confronted about it. Theres just an appropriate way of doing it. I have said in previous threads, that in order to do whats best for the childs wellbeing, sometimes we have to speak up even if it makes us the baddy. This isn't about the parent, this is about the child, and IMO not speaking up, is a diservice to the child and is not how I run my business.

[playfelt]

I think what it comes down to is letting the parent know when enough is enough and that what is being done at the moment is no longer working and it is time for a new course of action. That could mean saying ok the creams we are using now are no longer effective and it is time for something stronger or to rule out the need for something specialized such as due to an infection. That obviously means a trip to the doctor. I do like to remind parents who see this request as a need for time off that an evening walk in clinic is quite capable of diagnosing a diaper rash and prescribing the required ointments.

[MonkeyPrincess]

Yup, seen this many times, it's not about how clean the parents are keeping them. Some pees and poops can be more acidic and if the child has sensitive skin this can easily happen. I also swear by the clotrimazole in the foot aisle, only because it is cheaper than the one in the ladies aisle, not because it is any different (the pharmacist told me this). I recommend it to all my families with babies to have on hand just in case. I do the clotrimazole then a barrier cream (a thick pasty one) and then corn starch (not baby powder as it is not good for your lungs) to soak up moisture. Works like a charm every tim.

I agree with the above. The clotrimazole does work wonders and if you can get a generic version, even better!. My doctor and pharmacist also recommend that you mix in a bit of hydrocortisone with the clotrimazole, then apply a layer of diaper cream. I use Desitin extra strength because it is 40% zinc, versus some other 'good' creams like Penaten, Sudocream etc. that only contain 11-18% zinc oxide. The clotrimazole combats any yeast that may be lingering and they hydrocortizone combats the redness and stinging of pee/poop. I know this because my kids had very sensitive skin, my little one has eczema too. No matter what i did, they always had a diaper rash, my daughter more so than my son- like once a month. trust me, i have tried it all and no matter which way you slice it, my daughter has reoccuring diaper rashes, period! The good news is, since she turned 2 last month she has been taking her own diaper off. Might be a sign of diaper free days! :D