Hey, friends, today I wanted to delve into a topic about which many of you have questions. We're going to discuss rashes in young children and babies. Specifically, why do babies and young children seem to have sensitive skin? Why might your child be more prone rashes than you are? Why do they get rashes when they are wearing a diaper, for instance? When you wear underwear, you don't get a rash from wearing underwear. If you wore a diaper for whatever reason, you might not get a rash either. Yet, your child might develop a diaper rash. How come ? Is it all your fault? Of course not but I want to give you the reason why it's not. Then I also want to discuss to discuss what to do with these rashes. In the end, I'm going to end with a special treat. I'm having my first guest on this show, and she's a dermatologist.
To give you some background, as a family doctor, I see rashes a lot, but you know what? As a family doctor, I have the opportunity to refer out to specialists if I have questions about a specific medical topic. Let's say that I have really evaluated a rash. I've done a skin biopsy. I've treated it on my own. I've really worked this rash up and down, and the rash doesn't seem to be improving. The patient is unhappy, and I just want to help them and their rash. Guess what I do? I refer my questions about rashes to my colleagues - the dermatologists. Thus, over the series of the next few posts - all marked with #023 and corresponding to podcast #023 - not only will I talk about rashes, but I will also bring on a skin doctor - a dermatologist - to discuss them.
The topic of skin rashes is important to me for several reasons. First, if your child has food allergies, chances are that they also have rashes. Not always but often enough! Second, if your child has challenges around food or picky eating, what might be doing instead of eating their food? How about putting it in their mouths, moving it from side to side, spitting it out, and drooling... if you can even get it in their mouths? Third, what if your child has a feeding tube? Children with G-tubes often develop rashes around the site of the tube. Fourth, there's some stigma associated with rashes. Even the common diaper rash can bring fear to the eyes of some parents, and I'll explain how.
In medical school, I was taught that it was my duty to report any suspected cases of child abuse. If I did not report them, then I could be held medically liable especially if something happened to the child... If I suspected child abuse, did not report it, and the child eventually died or had some tragic injury, I could be held partially responsible. The professors would tell us, "You must report! You must report! You see this is or that symptom, and you must report or else...." The professor would go through a list of symptoms that could potentially signify chid abuse.
One of those symptoms was a diaper rash. Yes, a diaper rash! If you are anything like the mom version of me, then your child developed a diaper rash at some point. The thought of you being reported to child protective services for your child having a diaper rash seems a crazy. It's seems like crazy talk! People, if you are anything like the doctor version of me, then you have seen tons of children with diaper rashes, and you likely haven't reported a single child with a diaper rash. Quite honestly, I do not think that a doctor is going to report a parent to child protective services if their child has a diaper rash. It would have to look very suspicious. As doctors, we're pretty sure that our professors told us in medical school that the rash has to look very suspicious for child abuse for us to do any kind of reporting. Like really suspicious!
What would a very suspicious diaper rash look like? It would be one that is accompanied by other signs of parental neglect. For instance, little John goes to daycare, and at daycare, the staff notice a severe diaper rash They call mom and ask her, "Can we put a special cream around your child's buttocks to help prevent the diaper rash from getting any worse?" Mom answers, "Sure!" With daily treatment with the cream at daycare, the rash goes away. It comes back again after little John takes a break from daycare. It gets treated again at daycare. Then little John again doesn't go to daycare, and the rash comes back. To the person at daycare, it appears that the only place where little John's diaper rash is treated is at daycare. The daycare starts to wonder, "Is the mom not taking care of her child?" They might call child protective services for parental neglect. This was a situation where the cream almost resolved the diaper rash, and once the cream seemed to have been stopped, the diaper rash came back. Then again, in this situation, the daycare might be more likely to call child protective services than a physician. We tend to really like and believe our patients. (By the way, shameless plug! My book - "The FPIES Handbook" - has a whole chapter dedicated to child protective services.)
Yet, what if the cream did not treat the diaper rash? What if the daycare put the cream on little John and nothing happened? What if he continued to have diaper rash? What now? Perhaps not all diaper rashes are due to excessive moisture in the diaper area, increased pH, friction, and chemical irritation of the skin inside the diaper from urine or stool. Perhaps not all diaper rashes are due to diarrhea that is more likely to happen if a young child who has food allergies. There are multiple medical conditions that might mimic a diaper rash.
I will give you a list of five medical conditions that look like diaper rash but are not.
1. Psoriasis. This can be hard to diagnose and is uncommon in babies since most people get psoriasis when they are teenagers or adults. Psoriasis consists of red scaly patches on the skin, but in a baby, it might show up as red, non-scaly rashes around the folds in the groin area. Babies with psoriasis might also develop scaly red rashes on the scalp which are not to be confused with dandruff or cradle cap.
2. Langerhans cell histiocytosis. This condition is rare. The rare baby who has Langerhans cell histiocytosis develops scaly, red "pimples" in skin folds.
3. Biotin deficiency which is otherwise known as deficiency of vitamin B1 or vitamin H. Testing for this might be part of newborn screening, and it's rare for babies to have a biotin deficiency. If they have one, a diaper rash is usually not the only symptom. There might be hair loss, trouble breathing, seizures, and weak muscle tone.
4. Infection due to yeast (Candida). This condition is different from a regular diaper rash. First, it doesn't respond to the standard skin barrier creams used to treat a diaper rash. The rash can have additional spots outside of the border of the main rash, but really, if it's been a while and the diaper rash isn't getting better with standard diaper creams, this is a condition to consider. It's more common than the other ones.
5. Diaper dyes and fragrances to which the child has an allergy or sensitivity. Yes, a baby has sensitive skin, and that skin can have a "allergy" to chemicals found in some diapers.
OK... You got 5 different medical conditions that aren't your regular diaper rash. Each of these medical conditions requires different treatment - not just use of the cream that helps with a diaper rash that tends to go away on its own. If you are not sure if your child has one of these other conditions, make sure to see your child's doctor. I'm sure that many of them have seem quite a number of babies or young children with rashes or "sensitive skin".
This brings us to my next question. Why do babies get so many rashes? What do these rashes say about food allergies? We'll discuss this in the next blog post as I'll have a guest come on my blog and talk about rashes in babies.