A nappy (diaper) rash is not a reflection on the mother or a sign of neglect, but a very common problem. The baby develops an angry red area of skin under the nappy due to excess moisture on the skin from wet nappies, pilchers and plastic over-pants that can cause skin damage, eczema and fungal infections (tinea cruris). Overbathing, soap and detergents left in nappies may also irritate the skin.
Red, pealing, irritated skin appears on the buttocks. If the skin folds are spared, it is probably a pure dermatitis, but if the rash extends to the skin folds and there are red satellite lesions beyond the edge of the rash, it probably has a fungal component. Uncommonly bacterial infections may occur.
Zinc cream, lanolin or petroleum jelly applied to the bottom will protect it against moisture, and fungal infections will settle with antifungal creams, but eczema may require a mild steroid cream. The results of treatment are good, and even the most resistant cases settle once the child is toilet trained.
See also SEBORRHOEIC ECZEMA; TINEA CRURIS
Vomiting, and the nausea that usually precedes it, are some of the most common symptoms experienced by humans, and are almost unavoidable at some time in life. An enormous range of infections, gut diseases, liver disorders, brain conditions, glandular disorders, and even urinary tract abnormalities, as well as many other problems that cannot be easily categorised, can cause nausea and vomiting.
The causes of nausea and vomiting in babies only is discussed below.
Gastroenteritis is the most common infective cause of vomiting, and it is usually associated with diarrhoea. A viral infection is the normal cause, but bacteria may sometimes be responsible. The infection is passed from one person to another by close contact or on the breath, and usually occurs in epidemics, often in springtime.
The nausea and vomiting associated with sea sickness, car sickness and other motion induced forms of vomiting is due to an inability of the brain to co-ordinate what it is sensing from the balance mechanisms in the inner ears with what is being seen by the eyes. In a ship, the cabin appears to be perfectly still, while the balance senses movement. For this reason, watching the horizon while on the ship deck enables the brain to see the motion and reconcile the visual and balance senses.
Severe pain of any cause may result in nausea and vomiting as a reaction to the pain.
Other causes of nausea and vomiting include meningitis (infection of the supporting membranes around the brain), many different bacterial and viral infections (eg. cystitis, sinusitis), gastritis (inflammation of the stomach from acid irritation), appendicitis, mesenteric adenitis (infected lymph nodes in the abdomen) and a an increase in the pressure of the cerebrospinal fluid (CSF) which surrounds the brain and spinal cord due to ahead injury, tumour, cancer, abscess or infection in the brain or surrounding tissues.
Less common causes include uraemia (kidney failure), malaria, intussusception (infolding of the gut on itself, usually in children), epilepsy, a reduction in the blood supply to the brain (from suffocation, near drowning, inhalation of smoke or toxic gases, narrowing of the arteries to the brain, or any form of heart failure), abnormalities of most glands (may affect the body’s chemical balances), poorly controlled diabetes, hyperthyroidism (overactive thyroid gland), altitude sickness, and an anaphylactic reaction (immediate, severe, life-threatening reactions to an allergy-causing substance).
In infants, particularly boys, severe projectile vomiting may be due to pyloric stenosis (narrowing of the drainage valve from the stomach).
Many medications may have nausea and vomiting as a side effect.
There are many other rare conditions that may have nausea and vomiting as a symptom.
The management of nausea and vomiting involves identifying the cause, and treating that if possible, or using antiemetic medications (eg. metoclopramide, prochlorperazine, promethazine).
See also GASTROENTERITIS
Night terrors (pavor nocturnus) occur in children who wake suddenly in fright with crying, a rapid pulse, rapid breathing and sweating. They normally cannot recall a nightmare, but feel threatened and anxious. It may be an occasional or recurrent problem, and is if necessary can be controlled by low doses of mild sedatives to break the cycle. Children usually grow out of the problem after a few months.
See also BABY SLEEP PROBLEMS
Everyone will have experienced the sensations caused by a viral (eg. common cold) or bacterial (eg. sinusitis) infection in the nose, or rarely a fungal (eg. Candida) infection, that results in the excessive production of thick sticky phlegm and mucus.
Hay fever and vasomotor rhinitis may swell the lining of the nostrils and produce so much watery mucus that they become blocked.
Polyps are quite common in the nose, and may enlarge to completely block one nostril. Other growths, such as tumours and cancers, may also do this, but are quite rare.
The nasal septum (mid line divider of the nose) may be pushed to one side and block a nostril due to a birth defect or a fracture of the nose.
The incidence of diphtheria in children is now low due to vaccination. It causes a sore throat, thick grey sticky membrane across the throat, fever, nasal discharge, hoarse voice and obvious illness, with overwhelming tiredness and muscle aches.
Numerous medications may have a blocked stuffy nose as a side effect. Significantly, most decongestant sprays that are used to clear blocked noses will actually make the blockage worse if used too often or for too long.
See also COLD, COMMON; NOSE DISCHARGE
By far the most common cause for a runny nose is a viral infection such as common cold or influenza, or a bacterial infection such as sinusitis. Viral infections usually have a lightly coloured discharge, but in bacterial infections the patient is sicker with a fever, face ache and green or dark yellow discharge.
Hay fever (allergic rhinitis) is the next most common cause. The discharge is watery and profuse, and sneezing may be almost continuous, but the patient is otherwise well. Almost any substance (eg. pollens, dust, chemicals) may be inhaled and cause this reaction in a sensitive individual.
Vasomotor rhinitis is a reaction of the moist lining in the nose to a change in temperature (eg. walking into an air-conditioned room), position (eg. lying down), eating hot or cold food, or drinking (particularly alcohol) that results in the production of copious amounts of watery mucus. The problem usually settles after ten to thirty minutes, unless there is a further irritation of the nostril.
Children often place objects in the nose, and they may be difficult to see without proper instruments. A foreign body may be the cause of a nasal discharge, which is often infected, in children and adults with subnormal mentality.
See also COLD, COMMON; NOSE BLOCKED