questions about my in tact toddler

[EMAID]

I am new to this forum, and I've only posted on mothering a few times here and there.
I have a 22 month old in tact son. For the past 3-6 months we have been having general problems with diaper rash. I use Fuzzi Bunz cloth, and I've tried stripping them and using vinegar in the rinse, and we've also tried every brand of rash cream available in the general market thats compatible with cloth diapers. We've also tried a prescription yeast cream that we had from an obvious yeast rash my daughter had had (a mix of hydrocortizone cream and Nystatin). All of these would take the redness away a bit, but it would come back. It seems like his poops are giving him an acid-like burn on his bottom, so if he poops and we don't catch it and change him immediatly, he's all red.
Now, the reason I'm posting this here. Last week the usual rash started spreading, and he has some rashy spots all the way up at his waist, but what worries me more is that his penis and testicles are all red and sore-looking. I am ashamed to admit this, but despite having an in tact son, I have not been very careful about defending him from retraction. Actually, until I read the stickies in this forum, I wasn't aware that "just looking at the tip" was considered retraction. His doctor has done this, and I have too. Please don't yell at me, I really didn't know! Anyway, the thing is that he has never seemed to be in pain whenever I remember it happening...in fact, it seemed like it kind of relaxed him cause someone was playing with his penis. In fact, he plays with it himself all the time (which I know is normal), but he is pretty violent about it, yanking his foreskin forward and such. His foreskin seems like it's long compared to his penis if that matters.
Anyway, yesterday I let him go diaperless all day, and in addition to remaining red, his penis and testicles also became very dry throughout the day. By the time my husband came home from work I was pretty worried, so I took him to the ER. (We are looking for a new ped. right now.) Thankfully, the ER dr said he didn't want to touch it because he wasn't a ped., though he did instruct me to retract and clean underneath, which I know isn't right. So his advice wasn't helpful anyway. He did prescribe a mycelex-type yeast creme, but I haven't had a chance to pick it up yet.


So...my question is, what do I do? The ER dr mentioned that it's possible for them to get a yeast infection/bacterial infection under the foreskin. Since I've already tried one external yeast creme, does that rule out yeast? Or would that not work if the infection was under the foreskin? I have no idea where to go to find a non-circ friendly dr in my area, and I'm afraid that if I let this go until I do find one the problem will be a lot worse.

What do you all think I should do?

[dynamohumm6]

s:
I'm sure others will have more thorough advice, but I would say to use the cream OUTSIDE...obviously you know now to not retract the foreskin at all, not even a little bit. Give it a few days and see what happens, especially now that you know to not retract him at all. he may just be irritated from that. how long has it been since you've last retracted him?

Also, have you investigated a food allergy? It sounds like that may be a strong possibility, especially given the acid-like burn you describe.

edit: also, did the dr do a culture of any kind to verify that it was yeast? It could be possible that he has an infection from the retractions, but I'm not that well versed in that info, so hopefully someone else will chime in.

[kldliam]

So...my question is, what do I do? The ER dr mentioned that it's possible for them to get a yeast infection/bacterial infection under the foreskin. Since I've already tried one external yeast cream, does that rule out yeast? Or would that not work if the infection was under the foreskin? I have no idea where to go to find a non-circ friendly dr in my area, and I'm afraid that if I let this go until I do find one the problem will be a lot worse.

What do you all think I should do?[/

Hello. Sorry to hear your little one is dealing with such a bad rash. I am not sure what your question pertains too. Do you mean what do you do about his external rash (i would say to use the script from the ER dr. a.s.a.p.) or what to do about a potential infection under the foreskin?

Which leads me to ask, how do you know that there is an infection/rash under the foreskin? It sounds external from what you describe. I wouldn't advise putting any of this cream that the ER Dr. prescribed under the foreskin until you are certain there is an infection under there to begin with. I would stick to yeast creams that are meant for internal body cavities , should he have an infection under his foreskin. This script may not be meant for that. Did the dr. advise you to use it that way? I am thinking Monistat for that area...if there is a problem that is.

Also, how is your son’s behavior? Is he miserable? Is he complaining alot? Urination difficulties?

3. Is he fully retractable yet? If yes, do you retract him to rinse in clean soapless water everyday? If he is retractable, what does it look like underneath? Infection and rash? I don't think you mentioned that yet.

My son had very bad rashes at this same age. It must have been something in his food, because his poops were absolutely TOXIC to his skin! I used Nystatin during the outbreaks for like a year until it mysteriously disappeared. The rash never spread to his penis but sometimes his testicles would be bright red & raw looking. It always made me feel so helpless to prevent it, but that Nystatin always cleared it up quickly.

I think that your son might need to see a Dermatologist if this script from the ER dr. doesn't work. Maybe you can get a referral from your Pedi?

[workinmama]

From what I understand the penis shouldn't be retracted until it becomes "unattached". Do you know if it is still attached or fully retractable at this point...every boy is different? If you can easily retract it than it is now unattached. Don't be affraid to pull it back slightly and clean it or put the cream there if that is what the doctor recommended.

[workinmama]

I may sound like the anti-christ here but maybe take a break from the cloth for a couple weeks.

[dynamohumm6]

Originally Posted by workinmama

From what I understand the penis shouldn't be retracted until it becomes "unattached". Do you know if it is still attached or fully retractable at this point...every boy is different? If you can easily retract it than it is now unattached. Don't be affraid to pull it back slightly and clean it or put the cream there if that is what the doctor recommended.

I have to say I disagree - if he's been repeatedly retracted before it was ready, his foreskin could be trying to reattach itself, and continuing to retract him could just keep creating microtears, which is what could be causing the current problem.
The doctor also recommended retracting to clean underneath it, which is wrong, so I wouldn't trust that he knows what he's talking about if he said to put cream underneath. Especially if he didn't even bother to do a culture.

[glongley]

Your description does not sound like an infection under the foreskin so much as an extension of the red rashy irritation all over his perineal and groin area. I would get that external inflammation under control first, and then see if there's any residual redness, swelling, pain, etc. specific to the foreskin. If he didn't have his foreskin, he would be having it on his glans and urethra!

I second the idea to try paper diapers for a while. Or maybe diaper service. More or less an experiment to see if that's part of what's causing this. We cloth diapered both my intact sons, but we did our own washing with the first one, and he had frequent and extensive foreskin irritations and diaper rashes, whereas we used diaper service with the second son and he never had any problems at all.

His foreskin and scrotum probably looked dried because the surface cells which have been inflamed and damaged are shedding a bit.

Air drying is always a good idea. And considering aspects of his diet (sugar, allergens). You might try baking soda baths to neutralize the acidity of what's been getting on his skin. (Recommended to me by Dr. Paul Fleiss, "foreskin-friendly" doc extraordinaire.)

Good luck! Gillian

[stacyann21]

Ugh, that ER doc was an idiot. DO NOT retract him, it sounds like you know better . If Applying the anti-fungal on the outside isn't sufficient you may want to try a systemic anti-fungal. There's no reason to put anything under his foreskin. Also just an aside, tugging "violently" on the foreskin is pretty normal behavior for a toddler. If it hurt, he wouldn't do it. I hope he's feeling better soon. I second skipping the CD's for a couple days :

[Cherries10700]

I am not sure about the rash and yeast stuff, but I wanted to agree with some of the ladies that my first thought (when you said how bad his skin got after poops) was that it's a food allergy.
My good friend's daughter got a horriable rash on her bottom from ANYTHING apple, and my daughter got the same from ANYTHING strawberry. Might be worth looking into.
Best of Luck to you and your little man!

[PuppyFluffer]

I, too am thinking that a rash from poop on his skin would be caused by a food that is not working for him. May I suggest you post this issue in the Allergy forum here. You may get some great insight from others who have dealt with this who may know some common offending foods that you can remove from his diet.

With my older dd, kiwi did this to her. We removed it from her diet and never got a red irritated rash like that again.

I am guessing that he is having a secondary infection, either fungal or bacterial, due to the initial skin irritation caused by the poop on his bottom. Once the skin gets irritated and inflamed, it opens up an environment that is conducive to bacteria or yeast taking up residence but this is most likely only allowed due to the initial irritation, I am guessing. If you can fix the poop=irritation issue, the rest of it will resolve.

[Cassandra M.]

I agree with the above poster who said take a break from cloth until it gets cleared up.


I would make sure your diapers don't need to be stripped as well.

[EMAID]

Just to answer a few issues that have come up...

He was in disposable diapers all last week while we were visiting my parents over Christmas. This redness and dryness actually started while he was in disposables, so I doubt that going back to disposables would help.

I wouldn't exactly say that his foreskin was retracted repeatedly or often or anything like that. His doctor used to pull it back a little bit at each well baby appt. I never even saw the head of his penis, but according to the stickies on here, that still qualifies as retraction.

I don't know if it is retractable yet. How do you know? Everything I've read says that he's young to have it be fully retractable, and that you don't need to check because the boy will play with it and "show" you himself that it retracts. That has not happened, ds is more into pulling his foreskin forward than back. (It's kind of funny actually, he yanks on it and then the loose part of skin at the front looks like a loose sock or something.)

I'm totally in agreement about the food allergy idea. I tried mentioning this to the ER dr. but he said that if he hadn't taken any medications I didn't need to worry about allergy. (ie., No one is allergeric to anything other than medication?? GRrrrrr) I hesitate to try an elimination diet because he is quite small for his age and is always teetering on the edge of being labelled FTT, and now we're looking for a new ped...... My DD was labeled FTT, and they forced us through the blood tests and it was just about awful, and nothing was wrong. I can say that I just recently started giving him cow's milk to drink, but he's only having a few sips here and there, and not even everyday. I can't think of anything else he's eating that he wasn't eating before this started, but it's been so long that I'm not sure.

As far as behavior, that is one thing that is reassuring; he is acting totally happy and normal. The only time he complains about it is when he gets wiped, or if he makes the mistake of dragging his naked butt across the carpet. But otherwise even touching it doesn't seem to bother him. He's loving this no-diaper thing, it's like he got a new toy.

Other questions....Yes, the dr did tell me to "try" putting the cream under his foreskin. The cream is called Mycelog, and the doctor said it was mycelex. We are military, so we get prescriptions for OTC drugs a lot cause we can get them free then. So I believe that the cream would be OK for internal (assuming it's the same thing one would use for a vaginal yeast infection). But I'm not planning to do this, I don't think he's old enough to be retractable yet.

How long has it been since his foreskin was retracted? I did it once today right before I read these posts, but other than that it was only happening at his dr's appts, so the last time would have been September.

I still haven't tried the prescription cream. I'm just so busy right now I haven't had time to get the pharmacy.

[kldliam]

emaid: I don't know if it is retractable yet. How do you know?

emaid: How long has it been since his foreskin was retracted? I did it once today right before I read these posts, but other than that it was only happening at his dr's appts, so the last time would have been September.

Did the foreskin retract back over the head of his penis with ease or did you have to apply pressure to get it to retract? This will answer your question.

Did it look like there was unusual redness or infection when you looked? I would really try to treat the external stuff asap and not worry too much about what's under his foreskin; that is unless he is truly uncomfortable when he unrinates.

[eepster]

Originally Posted by EMAID

He was in disposable diapers all last week while we were visiting my parents over Christmas. This redness and dryness actually started while he was in disposables, so I doubt that going back to disposables would help.

Maybe the disposables contributed to his current flare up.

Originally Posted by EMAID

I'm totally in agreement about the food allergy idea. I tried mentioning this to the ER dr. but he said that if he hadn't taken any medications I didn't need to worry about allergy. (ie., No one is allergeric to anything other than medication?? GRrrrrr) I hesitate to try an elimination diet because he is quite small for his age and is always teetering on the edge of being labelled FTT, and now we're looking for a new ped...... My DD was labeled FTT, and they forced us through the blood tests and it was just about awful, and nothing was wrong. I can say that I just recently started giving him cow's milk to drink, but he's only having a few sips here and there, and not even everyday. I can't think of anything else he's eating that he wasn't eating before this started, but it's been so long that I'm not sure.

Cow's Milk is an extremly common allergen in babies and young children. It would not only explain his rash but might be the cause of the FTT. If he has had milder symptoms before you started giving him dairy products that is likely from you passing along through your breastmilk protiens from dairy products you ate. (I can't have any dairy b/c DS is dairy sensitive and I'm breastfeeding him.)

A short term solution might be to do potty learning (it obviously has long term benefits aswell.)

[MCatLvrMom2A&X]

Even if he is retractable right now with what is going on you shouldnt pull back his foreskin anyway. Because it could introduce the bacteria into micro tears caused by just a tiny bit to much pressure.

Personally I would insist on a culture if you can find a Dr. I know you said you were looking for one. This will prove exactly what is going on so that you wont have to guess at the treatment.

[Cujobunny]

Oatmeal baths can help with the redness, dryness and irritation. I use Baby AVeeno Oatmeal bath treatment but I think you can just grind up oatmeal to a powder and put in it a lukewarm bath.

[AXEius]

if the whole area is a rash, why on earth would the doctor or anyone else even be talking about his foreskin or the "proper"way to care for his penis?(their proper way to care for a foreskin is the fast track to injury, pain,phimosis and infection.) As far as the rash is concerned, all kinds of food related things can give rashes to those still in diapers. Imagine if you were sitting in a diaper full off the squirts after you at some really spicy mexican food. Sometimes that hurts just coming out let alone sitting in it. My daughter used to get a horrible rash from eating cheerios....cheerios, i dont know why but she did. She would also get rashes from drinking too much juice(too much acid?). we nearly removed cheerios from her diet and cut her juice 50% with water and ruduced her intake of juice and the rahes went away. My point is that rashes are often not infections but skin irritation and i dont have a clue why anyone there even mentioned the word foreskin because you son has a rash.

[dynamohumm6]

Did the rash just show up after you started on cow's milk? Even a tiny bit of dairy can have a really nasty effect. I know little kids who are breastfed, and if their mom has a cookie that has milk in it, they have the acid-burn butt. It doesn't take much.
I would eliminate dairy altogether, bearing in mind that it takes a couple weeks to completely get out of the system. I'm sure the allergy board would have some great ideas of what you could give him to replace the calories from the milk, but I'd be willing to bet that's the culprit.

[cristina63303]

My DS2 had a HORRIBLE rash at 6 months. It cleared with anti-yeast cream. He's prone to eczema, though and I use Lipikar regularly on his skin. It's the ONLY product that keeps it eczema-free.

Oh, and, OF COURSE NO RETRACTING!

[Isaac'sMa]

Bleach your dipes!

If it is truly a yeast infection, just stripping the diapers (with vinegar etc) may not be enough. I know bleach is a huge NO-NO for cloth diapers, but a capful or two in a HOT (really hot) wash would kill any yeast clinging to the diaper and not kill your dipes. : It might be called for in this circumstance b/c the diaper may be re-infecting him and that's why maybe the creams you've tried aren't working. I also agree with others that no diaper may be best for a few days. If he appears dry again in the genital region while going diaper-free, try a tiny bit of olive oil a few times a day on the affected areas.
And, please, don't retract him again!

ETA make sure to give the dipes an extra rinse if you do decide to bleach them!