2 related Q?s re: 1) Mystery rash around mouth & 2) Fully weaning a 4 year old ---> UPDATE Post 8

[CathMac]

Cross posted in Breastfeeding Beyond Infancy

DD2 developed a rash around her mouth some time ago. My best guess is back in December. We've alternately treated it with frequent washing and various steroids, including a heavy duty one DH had for a bad case of poison ivy (to reduce the inflammation so she'd stop picking at it) and ultimately a prescription antibiotic (prescribed by DH's allergy doctor for the rash when DH took DD1 and DD2 to be seen for their post nasal drip and possible asthma).

The antibiotic made sense because the rash seemed to clear up when she was on an oral antibiotic for a respiratory infection.

Maybe we weren't consistent enough since she has several caregivers (Me, DH, and my mom) or maybe it's because her older sister seems to have picked up a milder version but it never really goes away.

I'd thought about trying to treat it with EBM but I stopped pumping about 2 years ago and I thought my supply was pretty much gone. I tried weaning her about a year ago when she turned 3 and it seemed to take but after 2 weeks she started asking to nurse again. So we'd go through the motions but she seemed to have forgotten how and eventually when I asked her if there was any milk left she'd alternately say yes and no. I'm guessing she was getting something, but not much.

Leading up to her 4th B-Day I introduced the idea of weaning with no intention of pushing. I've been trying to distract, re-direct, etc. I became a little more insistent and better at putting her off when I found a small patch of rash running down the middle of my chest and when I started to get an unpleasant tingling, radiating sensation in my nips/breasts that reminded me of a thrush infection. (I thought that maybe I'd caught her rash and didn't want us to keep re-infecting each other).

However, the rash is pretty much gone (I now think it was heat rash) and I'm now fairly sure that the tingling sensation is actually fullness from what little milk I have backing up.

Sooooooo, I've been ignoring the fullness and discomfort but I'm at the point now where I feel like I should either dig out the pump (which may be too old and inefficient to pump effectively now) or apply some cabbage leaves. Of course if I do pump it might be an opportunity to put the anti-bacterial properties of EBM to good use.

More than anything I'm looking for moral support and encouragement because the house is small and crowded (e.g. cluttered) and just finding an electrical outlet, much less the time and privacy, to pump would take a lot of effort.

TIA for any input, suggestions, feedback, etc.

~Cath

[4evermom]

My ds used to get a rash like that. I attributed it to food allergies. I'm pretty sure it was dairy related and maybe also soy. ANd he seems to have outgrown it. It was tricky because it would take a couple weeks to clear up and hard to keep him off the suspect foods long enough. The thing to do is probably to try an elimination diet. Do it with both kids since they both are getting the rash. They might be allergic to different things, though. The other tricky thing about food allergies is they can be better or worse according to what other allergens (like airborne ones) the person is being exposed to. So you might not get a reaction to a food in winter but you might during the spring or summer if you have pollen allergies. Or you might get it worse in winter due to inside allergens like dust or cats.

Maybe try a topical antihistamine like benadryl creme on the rash? I didn't try that myself because knocking out dairy seemed to do the trick with ds.

[CathMac]

Originally Posted by 4evermom

My ds used to get a rash like that. I attributed it to food allergies. I'm pretty sure it was dairy related and maybe also soy. ANd he seems to have outgrown it. ...

Maybe try a topical antihistamine like benadryl creme on the rash? I didn't try that myself because knocking out dairy seemed to do the trick with ds.

I was kind of wondering about this. DD1 (with the milder rash) had a minor dairy intolerance when I was nursing her up until about age 1 1/4. It was manageable as long as I avoided obvious dairy, but I didn't do a strict elimination diet. DD2 didn't have any problem when I was nursing her and her rash is much worse. My suspicion is that DD2 caught something from a kid in her pre school class since someone told DH that another kid had some sort of rash around his mouth.

Unfortunately dairy elimination is unrealistic. I suggested that to DH when DD1 was little, before DD2 was born and to say he was unenthused would be a dramatic understatement. I suggested it again this past winter and the winter before when both of them had horrible post nasal drip issues resulting in upset stomachs and throwing up but I couldn't get him on board then either. We wound up using decongestants to control that. Fortunately that's not an issue now although DD2 is reporting the occasional upset stomach.

Oh, the thought of allergy testing has occurred to him but he's adamant that he doesn't want it done at this age. Having had the patch testing done myself I'm inclined to agree that's too uncomfortable for a 4 and 6 year old.

~Cath

[4evermom]

Originally Posted by CathMac

My suspicion is that DD2 caught something from a kid in her pre school class since someone told DH that another kid had some sort of rash around his mouth.

Eh, half the kids at that age seem to have some kind of rash. If it's around the mouth, it's something they are eating, IME.

Originally Posted by CathMac

dairy elimination is unrealistic. I suggested that to DH when DD1 was little, before DD2 was born and to say he was unenthused would be a dramatic understatement.

It's a matter of priorities and dh doesn't have to be enthusiastic. He just has to be willing to not sabotage your efforts. Buy almond or rice milk for the kids. Stock the house with non dairy snacks. Everything dairy can be found dairy free; ice cream, cheese, etc. He doesn't have to go off dairy himself so I don't see how it can be that huge of an inconvenience. It might cost a little extra but I think that's worth solving a child's chronic discomfort.

There's no magic way to find a cause and solution for this kind of thing so I'm not sure why you're bothering to ask for advice if you aren't going to try anything inconvenient to your dh.

[LuxPerpetua]

My dd (4.5) has had a rash like that a couple of times. We took her to our family dr. who gave her Mupirocin ointment for one, which cleared right up, and then for another we had to go a step farther and get Altabax, which cleared it up. For us, we had to be absolutely consistent in treating it 3 times per day. She only has gotten them occasionally, so I don't think they are food related for us.

As for weaning, we recently went that route. It's something I've been wanting to do for a while now (at least since she turned 4) but when I mentioned it to dd she was very resistant (she doesn't like change AT ALL). It actually happened because I was put on a medication that was unsafe for her to nurse with. I just explained that I had to take this medicine for 2 weeks and she would not be able to nurse. We started off with her just snuggling bare chested, and then to her holding my boobs, and now she holds a stuffed animal. Like I said, for us, it just sort of happened, but you may be able to concoct a similar kind of situation and see how your dd reacts.

[ecoteat]

DD gets a rash around her mouth sometimes. She hasn't in a while, and she is way more prone to get them in the winter when her skin is dry to begin with, but I suspect she may have some mild food sensitivity. I also suspect she may be outgrowing it. When she gets it, we put Weleda calendula cream on it a lot and it clears up pretty quickly.

If your dd is experiencing some reaction to food, and you are eating the same things she is, would putting EBM on the rash be counterproductive? I really have no idea if that's the case, but it seems like a possibility.

[JAL]

Just to give you something else to consider -

My dd had a rash around her mouth for about 6 months or more, we tried everything, antibiotics, steroids, anti-fungal through the pediatrician and dermatolgist. You know who finally helped me figure it out? Her dentist! She started talking to me about what it could be and as we were talking she mentioned it could be dust mites and I said that I had gotten her a natural latex pillow - light bulb went off - well, she is sensitive to latex! Totally dumb mom moment there, so we took away the pillow and away the rash went! She had been drooling at night and not using a pillow case caused the latex to have more contact.
At the same time we also stopped using a flouride toothpaste which can also be a culprit so you might want to look into that. We added that back in and no rash as of yet so I am pretty sure it was the latex pillow.

Hope something here helps!

[CathMac]

Originally Posted by LuxPerpetua

My dd (4.5) has had a rash like that a couple of times. We took her to our family dr. who gave her Mupirocin ointment for one, which cleared right up, and then for another we had to go a step farther and get Altabax, which cleared it up. For us, we had to be absolutely consistent in treating it 3 times per day. She only has gotten them occasionally, so I don't think they are food related for us. ...

LuxPerpetua,
What you describe seems closest to our situation so here's an update.

We've discontinued the topical steroid (Betamethasone Dipropionate Cream USP (Augmented), 0.05%. DH had suggested using it again to "knock (the inflammation) down" but I reminded him of why that wasn't a good idea. He does pride himself on thinking outside the box and he has a tendency to keep me on what feels like a need to know basis sometimes but I have to believe he hasn't been using it since we took 4 yo DD2 and 5 yo DD1 to the doctor. (Note, DD1 will be 6 at the end of this month).

DD2 just finished a 10 day course of IC Sulfamethoxazole tmp suspension. (1.5 tsp 2x a day). We have also been washing the rash 3x a day and following that with Mupirocin 2% ointment. She saw the Dr. last Monday and we were told to go in for a follow up if the rash wasn't gone in 7 to 10 days. Even though the rash was noticeably better we went in early, last Friday, because I wanted the same Dr. to see it and she was going to be gone this week.

So the rash is looking much better but it's still not gone, and it's not looking as mild as her older sister's rash looked. And DD1's rash is almost gone but she still has one or two teeny tiny patches (2 or 3 millimeters around). We've been treating her with the Mupirocin 2% ointment 3x a day but not the oral antibiotic.

I should add that when DH took them in for the follow up she suggested adding Hibiclens to the cleansing regimen. We had been using a regular anti-bacterial bar soap (Safeguard), which is something that an acquaintance told me her doctor had suggested. I wasn't there for the follow up visit but I get the impression from DH that she only reason recommended the Hibiclens as an alternative to the Safeguard.

If DD1's rash were all gone I would simply continue with the 3 x daily washing with Hibiclens, followed by the Mupirocin ointment but I wonder if it makes more sense to take them both in and request an oral anti-biotic for DD2 and a stronger oral anti-biotic for DD ... and/or request the Altabax that you suggest.

Is it reasonable to expect that their rashes will continue to improve and ultimately be cleared up on the Mupirocin alone or is it likely that whatever this is (probably some type of staph) will become (more?) anti-biotic resistant?

It sounds like you went through this more than once and it's finally gone so that gives me hope. How long has it been since the last flare up?

Thanks for the input.

~Cath

[emilysmama]

Cath,

When my dd was 1 year old, we did everything that you outlined above for two years, and it never really went away. Only difference is that the rash was in the neck. One allergist suggested early on that I go on a total elimination diet, because she was convinced that it was something passing through my breastmilk. In the end, after asking 3 other allergists, I decided not to modify my diet. To this very day, I regret not at least eliminating dairy. It took us 2 years, only once dd weaned and her cow's milk consumption dramatically increased, before I figured out that dairy is not a good thing for her. We're dairy free now, and it was actually pretty easy.

As for your husband not wanting to eliminate dairy... Who is doing the cooking in your household? If you are doing the cooking in the household, then I contend that it is easy to make dairy-free food taste very close to dairy food. It just requires imagination and an intuitive feel for flavors. Forgive me if I am mistaken, but aren't you the author of that fantastic homemade baby food cookbook that I absolutely loved and read while my baby was starting solids? If so, then you of all people can figure out how to keep him satisfied without dairy. If I can do it, then so can you.

[Holiztic]

DS had a peri-oral rash last summer for 3 months, I kept a detailed food log and had several theories. I did not treat the rash as we a) avoid harsh things like steroids and antibiotics and b) wanted to be able to see the rash as we tested for the cause--remember that symptoms are signals of deeper issues!

I thought I solved it when I learned about Ayurveda and decided he was severely overheated from summer AND the highly warming diet I was feeding him (salt, garlic, ginger, yogurt, honey, etc). When I cooled his diet AND the summer turned to fall, it went away.

Then in Feb we confirmed a mild citrus allergy. Mild in small amounts (faint pink spot on either side of his mouth for a few hours), but I think he was getting citrus every day that summer.

I am not sure this theory replaces the pitta-aggravating theory, I think they worked in tandem, as citrus is very warming. The daily grapefruit in Jan did not cause a rash, but perhaps citrus daily PLUS garlic, salt, ginger, AND MOST IMPORTANTLY 95 degree August were likely the problem.

I share this not necessarily because your child's issue is pitta-aggravation (over-heating) or allergy (though allergy is likely) but to encourage you to look more systemically/holistically at the problem to solve it from the bottom up, rather than trying to erase the rash.

Good luck, mama, I know how frustrating it can be, I look back at pictures of DS from August-October and feel that stress all over again!

[CathMac]

Originally Posted by emilysmama

Cath,

When my dd was 1 year old, we did everything that you outlined above for two years, and it never really went away. Only difference is that the rash was in the neck. One allergist suggested early on that I go on a total elimination diet, because she was convinced that it was something passing through my breastmilk. In the end, after asking 3 other allergists, I decided not to modify my diet. To this very day, I regret not at least eliminating dairy. It took us 2 years, only once dd weaned and her cow's milk consumption dramatically increased, before I figured out that dairy is not a good thing for her. We're dairy free now, and it was actually pretty easy.

As for your husband not wanting to eliminate dairy... Who is doing the cooking in your household? If you are doing the cooking in the household, then I contend that it is easy to make dairy-free food taste very close to dairy food. It just requires imagination and an intuitive feel for flavors. Forgive me if I am mistaken, but aren't you the author of that fantastic homemade baby food cookbook that I absolutely loved and read while my baby was starting solids? If so, then you of all people can figure out how to keep him satisfied without dairy. If I can do it, then so can you.

Emily'smama,
Thanks for the input. I'm pretty sure it's impetigo because it does seem to be responding to the anti-biotics and because my husband seems to remember a kid on DD1's bus having something similar. So she could easily have gotten it from her.

Regarding the dairy. I took a trip on that merry-go-round with DD1. I did a partial elimination diet --avoiding obvious dairy but not obsessing over hidden dairy in highly processed foods-- for myself until her "colic" more or less resolved when she was about 1 1/4 years old.

I had DD2 when DD1 was about 22 months old and DD2 showed different signs of dairy intolerance when she was very young. She wasn't colicky but she did have excess mucous production, and post nasal drip sometimes leading to vomiting. Interestingly, DD1 developed similar symptoms later (maybe as long as a year or so later), which is what led me to suspect dairy. But there may have been an environmental allergy component layered on top, possibly mold since --if I recall correctly-- DD1 developed the additional symptoms similar to her little sister's one summer when the mold count was particularly high.

I suggested to DH at the time that we try dairy elimination since it would only be harder when they got older. Keep in mind that I worked full time and DH was the primary care giver. And --simply put-- he seemed supremely uninterested. He did most of the shopping and cooking and he was the primary care giver. Even if I was inclined to take on the shopping and cooking I would have had no control over what he fed them during the day.

There's not much point in elaborating beyond that.

To answer your question, I have not written any cookbooks.

Again, thanks for the input.

~Cath

[CathMac]

Originally Posted by Holiztic

...

I share this not necessarily because your child's issue is pitta-aggravation (over-heating) or allergy (though allergy is likely) but to encourage you to look more systemically/holistically at the problem to solve it from the bottom up, rather than trying to erase the rash.

Good luck, mama, I know how frustrating it can be, I look back at pictures of DS from August-October and feel that stress all over again!

Thanks for the input. I finally seem to finally have DH on board with ditching the steroid which was merely disguising the problem.

As I mentioned in my last post, I'm pretty sure it's impetigo since it's responding to antibiotics. If it were diet/dairy related I would have expected the problem to materialize sooner in DD1. I do realize allergies can take awhile to develop or worsen but it does seem odd that both girls would develop the same symptom at the same time, given the almost 2 year age difference.

ETA - For the benefit of anyone else reading this I did find this Dr. Sears article. I plan on trying to follow the protocol he outlines for more persistent impetigo, as follows:

Dr. Sears Article on Impetigo
http://www.askdrsears.com/html/10/T110241.asp

If the infection continues to worsen despite the above treatment, then proceed with the following steps three times a day:

Wash with warm soapy water.

Apply a hot washcloth to the area for 10 minutes (this will improve blood flow to the area and help the body fight the infection).

Apply diluted hydrogen peroxide, than wash off after two minutes.

Apply 10% diluted Betadine solution (mix 1 tablespoon of this over-the-counter brownish red antiseptic with 10 tablespoons of water) and let it dry for two minutes.

Thoroughly wash off all Betadine.

Apply a prescription antibiotic ointment called Bactroban. ...

~Cath

[emilysmama]

CathMac,

I apologize for the mistaken identity. I also should have known better than to make assumptions without thinking. The rash certainly seems very challenging. I wish you luck in finding the solution, and hope that the suggestions from the knowledgeable PPs are helpful to you.