What healed my daughter’s eczema

Just a short little ditty here because I have another post planned but now that my daughter’s skin is [practically] pristine, I want to share some of the things we have learned:

1) Her skin is very sensitive to heat and sun – almost immediately with sun exposure or being in a very hot environment, R will get a heat rash, including red bumps on her cheeks and arms.   Cooling her down helps this rash calm very quickly.

2) Her eczema otherwise required simply the tincture of time to improve.  Interventions we used consistently, including frequent bathing, oatmeal baths, and thick emollients helped her skin heal, but it still had a bit of a rough, dry texture to it. Enter (once again) ceramide-containing creams.  These made a huge difference in turning the dry “eczematous” skin to smooth baby-soft skin. While her skin was very rashy with bad eczema the cream had made little difference, but after it was healed and simply in a dry phase, infusing her skin with ceramide definitely worked.

3) Traveling to Vancouver also healed my daughter’s skin – I attribute this to the temperate climate with fewer allergens and less humidity, but to be frank I do not have a truly good explanation about what worked about the journey. All I know is: Being there worked wonders for her.

4) Cutting nails short short short is still key for her – whenever I leave them long she scratches and it starts a new healing process for her, so I would still not underestimate this intervention! It really works!

5) It looks like food allergies were not really at play for her in terms of skin health, though for digestive health food restrictions (such as eliminating dairy and eggs) have really helped her.

6) Other things that we did that probably made no difference? Changing clothes detergents, changing soaps (though we do this in general because her skin is dry), selenium sulfide preparations.

Just a few thoughts on her eczema this evening. Cheers and happy fall!

Posted in Health, Medical Topics, Pediatrics, Personal Tagged with: , , , , , , , , ,

Treating my Baby’s Eczema: The case of the itchy scalp

I grew up with terrifically dry skin which, at first handshake, makes people think that I must be 67 years old — that is, unless they are staring me in the face and see I otherwise look about my age. Because of this, throughout my pediatric practice I have made it a point to get good at treating eczema – first through myself, then through recommendations to the many patients with eczema I treated in clinical practice.

Let it be a fitting thing that, just as I gave birth to my picky-eater first child, I should also give birth to a child with skin rougher and drier than my own. And that skin is giving me a run for my money.

Since a month or two of age I could tell that R’s skin was drier than the average infant’s – a bit of scaliness here, some flaking to the scalp there. As a newborn she used to lie in her crib and shake her head back and forth like a miniature Stevie Wonder. This is what I thought, at least, until she turned 4 months old and, with newfound control of her hands and fingers, she began to scratch her head and ears furiously as she shook her head back and forth. All this time she’s been itchy, I realized.

So out came the creams, salves, oils, and ointments. Not just the few that I had on deck, the ones I’d massage into her gingerly every day or every other day after a quick bath. I went from being the one to give advice on skincare to getting advice from every angle – mostly at my own frustrated behest. “Use Aquaphor!” “Give her a massage with [insert name of oil/ointment/cream here]“. Eat this, do that. Unfortunately, no matter what I do, I am not sure that people believe the truth of my predicament (as I constantly advised the same to my patients): no matter what I do, the skin doesn’t get any better.

It came to a head a few weeks ago when, covered with itchy red bumps and her scalp bleeding, my baby saw her to her pediatrician and was prescribed antibiotics and a light topical steroid. At that point, I decided to turn a new, entirely more disciplined leaf regarding my daughter’s skin. But to my dismay, just as we were getting a handle on things and moisturization was working, her skin got much much worse — with a severe viral infection atop the eczema — and we were back on medications. That struggle brought us to the dermatologist and has taken us even further into the realm of understanding regimented eczema care.

Here is what I have learned:

1) Itching really does make the rash worse. I could do all the skin care I wanted for days and days, but within about 5 minutes of finding utility for a particular sharp fingernail, my daughter could destroy weeks of effort. So it’s really important to control the scratching. So I cover her hands with socks, or put a stretchy, light hat on her head, or both, as an effort at damage control.

2) Be vigilant about fingernail length. I cut my daughter’s nails with a clipper exactly every day and a half and “prn” (which means “as needed” in medspeak). I don’t bother using a nail file – it makes her nails short but sharp, so clipper it is. And if I miss a day, she could end up a scratchy mess, so timing is key. Every nail, every other day.

3) Keep ‘em wet. Ongoing through the eczema debateOne question you may have about eczema treatment is whether to bathe multiple times a day and keep children in wet wraps versus the other end of the spectrum – barely bathe them at all. I’ll admit that this is an individual decision based on what works best in your child, but for us and pervading the more recent literature, a frequent moisture source is helpful. For my daughter, this means bathing at least once a day, and no ordinary bath. I no longer use soap or fragrances of any kind, but I am now about to give the colloidal oatmeal bath industry their biggest client. Every bath is an oatmeal bath with a 10-15 minute soak. (One hint – just get the plain fragrance-free 100% colloidal oatmeal – don’t get a “baby” preparation – if it says “baby” it WILL be more expensive and also comes in smaller quantities – save yourself a few bucks and just use less of the packet for one bath. Save the rest for next time.
ADDENDUM 8-6-2014: (See cross-outs above) and clarification here: As my colleague, an pediatric allergist, has noted, whether to keep kids wet versus dry is not really a debate – physicians are in consensus that regular soaking baths and especially wet wraps can improve eczema a lot. There are other treatments which he discussed – and about which I will not go into more detail here – like bleach baths, which can also really improve eczema. You can discuss alternate treatments with your doctor.

4) Selenium sulfide doesn’t work for everyone. As a public health pediatrician this was one of my most frequent treatments for patients with cradle cap or fungal skin issues, but my daughter’s eczema has a scalp component that is itchy, rough, and flaky. Using selenium didn’t do much for her itching and didn’t change the rash, but it did give her head an unpleasant odor that also affected her washcloths. Odor: just a tiny detail. It also stings her eyes and must be removed carefully. It may get another shot as we move into round two of skin care, but I’m not expecting miracles.

5) Massage two or three or six times a day with the most nourishing ointment or oil that you can find. My current concoction is a homemade preparation of coconut oil, vegetable shortening, olive oil, shea and cocoa butter, and jojoba oil. But to be honest just the plain coconut oil or shortening works fine. It’s important to check the melting temperatures of your products (it’s easier to apply if it melts easily in the hand) and check labels before you buy – a cocoa butter cream typically has a very small percentage of cocoa butter and lots of other additives. Same goes with other preparations that include the ingredients I have listed above. Probably the cheapest and easiest thing is to just buy a tub of vaseline or unflavored vegetable shortening and call it a day, and boy do they both work well! I haven’t tried Aquaphor, but there are also other more expensive creams I have recently tried which contain ceramides, which are a component in skin cells that are generally lacking in skin with eczema. Unfortunately these preparations haven’t helped my daughter much, so I don’t bother with that anymore.

6) Be willing to try steroid creams for the skin, if the doctor recommends them When my daughter’s eczema started to arise I was the last person who wanted to try steroid creams, but with her most recent flare they did wonders to calm down the rash with just a few uses, and now we are willing to have Judicious use of creams as prescribed by the doctor. It is important, however, to use these very sparingly and only as needed because steroid creams can thin the skin and are absorbed by the body – and too many steroids can affect hormones in the body, so still be careful.

7) Diet can be related to eczema As a very young pediatrician this was something that I didn’t buy into before, but now that it’s my own kid – dietary restrictions were some of the first changes that I made in my daily routine. The dermatologist mentioned that in her experience food allergies can be related to eczema, and I will never forget a child who I met in residency who had a terrible infected eczema case and when I met him a few months later, when several food allergies had been identified, he also had much improved skin. There may not be credence to me restricting my dairy and egg intake, but I have been able to manage this change and I do notice a change when I do “cheat” on the diet.

In any case I hope that this was helpful and I welcome questions and commetns. I have had lots of people suggesting various guidance and as I learn more I will try to post. In my new job I am writing a ton, so scratching that itch has made me blog much much less than I normally would, but staying off my computer at home has also meant me enjoying each day with the kdidies. Now time to enjoy a good night’s sleep!

Posted in Baby, Pediatrics, Personal Tagged with: , , , , , , , , , , , , , , , , , ,

6 things you didn’t know you needed for your new baby

Now that my second child is nearly 5 months old, I’m wiping the sweat from my forehead and wondering where the first half-year went?! She rolls around, sings a warbly “ahahahahaa” for me and her dad, and genuinely wins all of our hearts. Aside from her being a girl and needing girly-type clothes (which I didn’t endorse at first, until my sister-in-law’s retort the constant blues, greens, and browns: “I’m all for thrift, but this is getting ridiculous”), I didn’t think I really would need anything for #2 (heretofore known as “little R”).

But, lo and behold, the wallet had to open and the online purchases began anew. Because who has time to go to Babies ‘R’ Us? And a few items became added to the queue which I just didn’t realize would happen:

1) Silicone bottle nipples – Unless it’s been a scant few months between your last use of baby bottles, you’ve probably noticed the flexible bottle parts in your collection can get cracked, split, or generally distasteful, leading to a need to replenish certain items. But, like me, you may have thought that everything was hunky dory when you saw a slight yellowish cast to the silicone nipples and other bottle parts. Hopefully you didn’t think like I did and try to salvage these disasters. As it turns out, silicone breaks down more quickly than I thought, and once the bottle parts – most often nipples from bottles or pacifiers – become slightly yellow, the silicone is on the way to breaking down. Next it gets sticky and more yellowish, and the stickiness (as I came to realize), does not resolve with 2 handwashes and 11 runs through the dishwasher. I’m a persistent recycler, but with your new baby, it’s time to throw out the old bottle nipples and get some new ones.

2) Sleep sacks – with my first baby I gave up on swaddling pretty quickly – he broke out the swaddle right away and from a few months into life was sleeping very close and cuddly with mama. Well, as it turns out, my second baby also tried to break out of her swaddles, but I decided to persevere in this case and found that even though she was also a mover, she liked being squeezed tight and I ended up buying a special type of sleep sack to help keep her arms in but which was also flexible to the contours of her body. This definitely helped turn her into a 4 or 5 hour sleeper.

3) New clothes for mama - now that it has been several years – almost 4, to be exact, since I’ve been in tasteful non-maternity big mama clothes, my wardrobe is woefully out of date and any pieces to which I am particularly attached are pilling like crazy. And my skinny mama clothes are far from being wearable, as I am now convinced that I may never be able to fit into them again. So I’m treating myself, buying some nice looking clothing that will be suitable for work and not feeling guilty that one day it may not fit me the same. Gotta wear something now so might as well look decent and love what I got that’s not going anywhere yet! Now – quick plug which I won’t link to – I just signed up for Stitch Fix and am really enjoying the new duds! Cool choices and a nice surprise in the mail every so often!

4) Extra diapers / replacement parts for cloth diapers - Unfortunately, elastic ain’t what it used to be anymore. I have things made with elastic from 1992 which are in great shape and for some crazy reason a lot of my more recently elasticized stuff gets worn out often – translate, cloth diapers cannot hold anything anymore and are very stretched, and this is only for child #2. Unfortunately I’m not a great seamstress so the worn diapers are sitting in a drawer awaiting repairs and new elastic. But to ease the tide I purchased a few new diaper covers and, let’s face it, while having a full time job and two kids, well, cloth diapering has become less of a priority (though still is being used by me, if not by the rest of the family). So this also meant buying a boatload of (ugh) disposables – for daycare and for hubbie. Oh well, I’ll keep working on this one!

5) New Medicines Check the labels on your bottles, folks, because chances are that the acetaminophen and ibuprofen and vitamin D drop sand who knows what else are, that’s right, expired. And (like us) you will probably have that day when your 2+-month-old child gets a fever and you are plum out of medicine that you are willing to give your kiddie. And we had a lot of other things to hunt down as well, which fortunately we didn’t have to repurchase – like the thermometer for instance. Another essential.

6) New Breast Pump and Accessories At first I intended not to get a replacement breast pump; mine seemed to be working fine and I didn’t want to be wasteful, but with the Affordable Care Act it is now mandated that women be provided breast pumps through their insurance plan, and if you want to buy into this offering you must order the pump within 30 days of delivery. This meant that, if my old pump were to conk out today for instance, a new one would not be covered. So for that extra peace of mind I ordered a new pump, which ended up being very convenient because now I have extra pump parts as well so that I have a little less dishwashing to do!

Fortunately outside these items the list of purchases for the new baby (outside of clothing needs for a girl) is small, and when she was VERY tiny we were able to use a lot of the clothing we already had. It is nice that we got a lot of neutral linens/onesies for her as a youngster since that didn’t have to be replaced. And though I’m tempted to to go to the children’s stores and look for all the latest gadgets for kiddies (and there are many), my wallet is happy that I’m trying to open it a little less!

Posted in Baby, Cloth Diapering, Green Living, Personal Tagged with: , , , , , , , , , , ,

Before and After: The Haircut

Hair Donation Banner

 Part II

Here is the before . . .

Before the CutAnd here is the after!After the cutWhaddaya think?

Posted in Charity, Personal Tagged with: , , , , , , ,

My Kicky Spring Do(nation)

Hair Donation Banner

All you readers know that lustrous hair is one of pregnancy’s legendary desirable side effects. But what happens afterward? Yes, you may say, it’s simple but unsatisfying. The hair, having sustained a prolonged phase of anagen (hair growth), transitions to catagen (no growth) and then into a stage of telogen (hair falls out). And all that beautiful hair disappears.

Well, THAT hasn’t happened yet. And my hair is now weighty with leaden thick black hair. Not sure how it hasn’t turned gray yet with the way I feel like I’m up all night and day. Of course, I’m not crossing my fingers for the gray transition either.

But this coif is getting to be somewhat of a nuisance. When it’s down, my 1-month-old daughter’s tiny fingers with dagger-like Lilliputian fingernails wreak havoc on the hair, which gets tangled up in knots resembling those of my childhood. When put up, my hair breaks the clasps of my hair clips and stresses the elastics of my hair bands. And it feels like an anvil dragging me down. I know, I know, I shouldn’t complain when one day my hair will be thin and white, but there it is.

What do you do with an 8-inch lock of hair?

I’ve taken a ruler to my hair and lookee here, I can donate to a child who really needs it! We’ve all seen the viral video “Emily’s Hair” depicting the adorable three year old donating to Locks of Love. But to whom should I really donate? Pantene? Locks of Love?

20140314-110756.jpgAfter a bit of research I’ve decided to give my hair to Children with Hair Loss. This nonprofit organization creates 300 hairpieces a year for children with all sorts of illnesses leading to hair loss. They, like Pantene, accept hair of shorter lengths – as little as 8 inches – and also accept gray hair – which I think is nice because people with gray hair want to be able to donate, too!

Why not other organizations?

Well, this article from Forbes diverted me from Locks of Love, not to mention the fact that I don’t think I could donate the 12 inches of hair they require. Imagine, $6 million dollars of hair unaccounted for at the organization that probably gets the lion’s share of hair donations?! Pantene, which creates 1 hairpiece from 19 hair donations, is definitely worth a donation with the great and beautiful focus of women with breast cancer. But I figured that they probably get many many donations anyway through larger programs.

And finally, I’m a pediatrician – of course I want to donate my hair for children! So Children with Hair Loss it is. And I’ll get a “kicky spring do” to boot!

How do I feel about going short?

Love it, love it, love it. I can’t wait to be tangle-free. I can’t wait to not have to pull my hair back and to have it styled in 5 minutes and done. Okay okay, I don’t wear makeup. Neither do I use any type of product in my hair aside from a little oil here and there. But at least now when I am finished my hair will look like something, not the shapeless ponytail to which I usually relegate it. I’ve gotten my hair chopped off every few years, and it was the very year of 2006 when I last took the plunge that I met T, the man who would become my husband. So the aspect of short hair looks much more promising than not.

Not sure why I never thought of donating it but there’s a first time for everything. Here are some of the styles I’m considering. Your thoughts?  Stay tuned!

Posted in Charity, Personal, Pregnancy Tagged with: , , , , , , ,

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