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2 related questions re: 1) Fully weaning a 4 year old and 2) Mystery rash around mouth --->...

post #1 of 7
Thread Starter 
Cross posted in Ages & Stages, The Childhood Years

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
post #2 of 7
I'd go with the cabbage leaves.

Seriously, I'm not sure of the time-line here. When did she turn 4?
post #3 of 7
Thread Starter 
Quote:
Originally Posted by claras_mom View Post
...

Seriously, I'm not sure of the time-line here. When did she turn 4?
About a month ago.

~Cath
post #4 of 7
It's a tough call, Cath. I mean - if you found the pump and got it to work and all, then it's possible that pumping would stimulate production, which is not really what you want if you're trying to wean. I'd be inclined to treat the rash separately from the weaning issue - mostly, if it's hung on this long I'm not sure that the anti-bacterial properties of breastmilk would really knock it back. This might warrant a trip to the pediatrician (or a dermatologist), particularly since it seems to be mildly contagious.

In the spirit of full disclosure, I should say that I hate pumping and it would take a lot to get me to do it at all. I let both girls reverse cycle rather than pump.
post #5 of 7
Thread Starter 
Note, this update is cross posted in the Childhood Years.

Regarding the rash, 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 suggested by LuxPerpetua in "The Childhood Years".

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?

BTW, I did try pumping once and didn't get so much as a drop of milk, just half a drop or so of an oily substance. I did pick up some Fenugreek and Mother's Milk Tea, which I almost immediately misplaced and I haven't completely ruled out picking up a new double electric pump.

I am unemployed right now but I could find the money for that if I thought EBM would be a good supplement for the cleansing regimen and any anti-biotics (oral or topical).

Thanks for the input.

~Cath
post #6 of 7

Rashes

I am only replying to your post because I am a medical professional and can advise you in that way, but not from a mothering point of view.

First of all, and I don't want to beat you up for this, BUT----NEVER, NEVER, NEVER use medications that have been prescribed for someone else!! Especially if the prescribed medications were for an adult, and now you want to use it on a child. As I totally understand that your intentions were "good", this can be VERY dangerous. The "super-duper" steroid cream that DH used on a *BAD* case of poison ivy is not meant to be used around a child's mouth, especially where there is mucous membrane.

I am glad that you finally did take them to a doctor---however, if something like this is not clearing up by now, it is high time to get them to a dermatologist, who is the expert on funky skin things.

The rash could have more than one single cause---that is, it could have a bacterial component, a fungal component (because it is around her mouth, and the mouth is a mucuous membrane which keeps it more moist than normal skin), an inflammatory component (from her picking at it or rubbing it or licking her lips) and even an allergic component. This is the reason why the antibiotics help some, but don't *cure* it---it does not necessarily mean that the rash is "antibiotic resistant". So, to put them on additional antibiotics seems unnecessary until you find out what the root cause of the problem is. I am not a proponent of prescribing antibiotics willy-nilly if I don't know that the root cause of the problem is bacterial---antibiotics don't work on fungal infections or inflammatory reactions or other causes not related to bacteria, and this is the reason that so many bacteria have become resistant, because they were prescribed for no reason. Because she was picking at the area, that may have caused *some* bacteria to dive into the rash, and that could be why the rash appeared a bit better after the antibiotics. If it was resistant, there would be little to no improvement. I personally happen to think that prescribing anitobiotics without performing a culture and sensitivity on a suspected infection constitutes malpractice---how can you treat something when you don't know what it is?

A dermatologist could do a culture of the areas, which would definitively show what the cause is, and then proper treatment can commence and she'd hopefully get rid of it. I am not going to get involved in your decision to pump, but IMHO, spending the money on a visit to a dermatologist to find the root cause of the rash might be a better investment, since I really don't think that EBM is going to cure the rash, considering everything that you have already been using.

You say that if the rash was all gone you would continue with the Hibiclens wash and antibiotic ointment----why would you continue with antibiotic iontment if the rash is all gone? There is no need to do that. In my opinion, people go WAY overboard on all the antibacterial stuff----you have to be exposed to bacteria and germs to build up your immune system, and using antibacterial stuff and antibiotics all the time is not a good thing to do. The doctor may have recommended Hibiclens because Safeguard is heavy with fragrances which are very irritating by themselves.

Have you tried to just leave it alone, wash it with Ivory soap and let the air get to it, instead of smothering it with antibiotic ointment and steroid cream? It is possible that it could be some sort of localized dermal allergy----when I was a kid, my uncle used to do a lot of fishing and bring my parents fish to cook for dinner. There was one specific kind of fish that would cause me to get a severe rash all around my mouth when I ate it---it would turn beet reed and burn and itch like hell!! And then I would lick it, rub it and scratch it, opening up the skin and turning it into a God-Awful dermal thing. It was not an infection, but it sure looked ugly.

Also---kids around that age lick their lips a lot. If they lick, lick, lick (especially in cold weather), they get a red rash all around their lips that looks pretty ugly. It doesn't mean that it is infected.

Aside from taking the girls to a dermatologist, my recommendation would be to "rule out" the things that could be causing it, since it is a localized reaction, and doesn't seem to be getting worse---just because her sister has it does not mean it is contagious either. They could both have the same allergy or have gotten into the same things that caused the rash to begin with. I am sure you have had close contact with both of them, and if you and DH have not contracted it, it would be safe to assume that it is not contagious. And, I can add to that, STAPH IS VERY CONTAGIOUS!!! If no one else that they have been in contact with has contracted it, I could safely assume that it is not a staph infection. Furthermore, staph infections progress----it is doubtful that a rash that developed over 6 months ago would be in "status quo" mode if it were a bacterial infection. I would start looking at everything they put in their mouth, close to their mouth or that comes in contact with their mouth----food items, liquid drinks, plastic cups, dishwashing detergent, clothing materials, toothpaste, toothbrushes, soap, toys, etc. Also look at outside-of-the-home items too---things in school that they come in contact with, like crayons, pencils, paper, etc. Also---try to find out if any other kids in their school have anything similar. Different types of residue on things can cause skin reactions in people who are sensitive. Do you have any dogs, cats, or other animals? Do you have a rug or carpeting? Sometimes, even things like cleaning product residue on a sink or bathtub is enough to ilicit a reaction in very sensitive people.

Finally---since it is summertime and we can capitalize on nature's healing, maybe you should try to get them out in the sun, without sunscreen on their mouth areas, and let the sun get in the rash for a while to see if that helps. Many types of eczema and psoriasis respond very well to UV light!! You don't have to lay them out in the sun for 6 hours, but enough so that the sun can get to that rashy area. I remember my mother saying that when her kids got diaper rash, the best treatment was to leave the diaper off, lay us on our bellies in the crib and let the sun shine on our butts!! Many times, you are more successful if you let nature treat ailments, especially if you don't know what the ailment is and it is not an immediate threat.

I know that it is difficult, if not damn near impossible, to keep 2 kids that are your kids' ages from putting stuff in their mouths, touching their mouths, licking their lips, etc.---if you had to police that activity, you'd be doing it 24/7. And it probably drives them crazy that you are already washing their mouths like crazy and putting gooey ointment all over it. If it were me, I'd withdraw all "treatment" and start from the beginning. If nothing that you have tried is "curing" it, then that leads me to an allergic cause or some sort of skin condition like eczema. Eczema is a weird thing---it can come on out of the blue, for no good reason whatsoever, and go away on its own or hang around for a few months or a few years. The thing is, sunshine is THE BEST treatment for eczema!! Not hours and hours of skin blistering sun, but a little bit of sun every day. A nice mild soap like Ivory is good---Dove is also very good.

I can hear the frustration in your post----but please remember, your daughters are not dying here, they have a skin rash which is treatable. It is uncomfortable for them, and probably unsightly to look at, but it is not life-threatening or otherwise affecting their internal organs!! All the caregivers of your daughters need to be together on the treatment of this thing---you can't have DH putting steroid cream on it and using Safeguard with all its fragrance in it, and you doing something else, and your mother doing something else. Everybody has to do the same thing to ensure continuity of care.

I hope their rashes go away fast!!
post #7 of 7
Thread Starter 
Quote:
Originally Posted by DianeMarie View Post
I am only replying to your post because I am a medical professional and can advise you in that way, but not from a mothering point of view.

First of all, and I don't want to beat you up for this, BUT----NEVER, NEVER, NEVER use medications that have been prescribed for someone else!! Especially if the prescribed medications were for an adult, and now you want to use it on a child. As I totally understand that your intentions were "good", this can be VERY dangerous. The "super-duper" steroid cream that DH used on a *BAD* case of poison ivy is not meant to be used around a child's mouth, especially where there is mucous membrane.

...
DianeMarie,
Thanks so much for the detailed response.

Long story short, the antibiotics (oral and topical for DD2, topical only for DD1) seemed to make a dent but didn't clear the rashes up entirely. Towards the end of the 10 day course of oral antibiotics I added Dr. Sear's cleansing regimen (which includes moist heat, hydrogen peroxide and betadine) which also seemed to help but also didn't clear it up entirely. So we took them to the pediatrician and she gave us a list of local pediatric dermatologists but the earliest appointment we could get was weeks away.

So we wound up taking them to one in the city yesterday. The good news is he thinks that if it was impetigo it has cleared up and they now have some sort of irritation. He recommended washing with water and Cetaphil and discontinuing everything else.

They happened to have their regular physical today and their regular pediatrician says it seems to be clearing up. Of course it has to look better after discontinuing irritants such as hydrogen peroxide and betadine. Now that we have a new "baseline" I am hoping for further improvement. We have a follow up appointment in 3 weeks. I'm hoping it's all gone, or at least mostly gone, by then.

At DH's request the dermatologist did culture both of them for MRSA only because of the possible exposure via a relative with a known infection, keeping in mind that at least one person seems to have gotten it from him.

During the dermatologist visit I tactfully brought up the topical steroid and the Dr. did explain about rebounding.

Thanks again for the input.

~Cath
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Mothering › Mothering Forums › Toddler › Toddler Health › Breastfeeding Beyond Infancy › 2 related questions re: 1) Fully weaning a 4 year old and 2) Mystery rash around mouth ---> UPDATE post 5